Provider Demographics
NPI:1679033278
Name:MCDERMOTT, MACKENZIE
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 ROUTE 138
Mailing Address - Street 2:BUILDING 2 , SUITE 204C
Mailing Address - City:WALL TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-2670
Mailing Address - Country:US
Mailing Address - Phone:732-795-0411
Mailing Address - Fax:
Practice Address - Street 1:1540 ROUTE 138
Practice Address - Street 2:BUILDING 2 , SUITE 204C
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07719-0771
Practice Address - Country:US
Practice Address - Phone:732-795-0411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-21
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker