Provider Demographics
NPI:1619349412
Name:MCKENZIE, MELISSA (MA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 QUEEN ST
Mailing Address - Street 2:UMMMC, AMBULATORY PSYCHIATRY SERVICE
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01610-2473
Mailing Address - Country:US
Mailing Address - Phone:508-334-2670
Mailing Address - Fax:508-334-2780
Practice Address - Street 1:26 QUEEN ST
Practice Address - Street 2:UMMMC, AMBULATORY PSYCHIATRY SERVICE
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610-2473
Practice Address - Country:US
Practice Address - Phone:508-334-2670
Practice Address - Fax:508-334-2780
Is Sole Proprietor?:No
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program