Provider Demographics
NPI:1710471305
Name:MCKENZIE, KAREEM M (LAC)
Entity Type:Individual
Prefix:
First Name:KAREEM
Middle Name:M
Last Name:MCKENZIE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 UNION AVE STE 306
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-3262
Mailing Address - Country:US
Mailing Address - Phone:973-372-2624
Mailing Address - Fax:973-372-0103
Practice Address - Street 1:50 UNION AVE STE 306
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-3262
Practice Address - Country:US
Practice Address - Phone:973-372-2624
Practice Address - Fax:973-372-0103
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00340200101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor