Provider Demographics
NPI:1710766019
Name:MCKENZIE, ANNA CECILIA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:CECILIA
Last Name:MCKENZIE
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 1:860 BEACON ST APT 205
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-3121
Mailing Address - Country:US
Mailing Address - Phone:910-638-3224
Mailing Address - Fax:
Practice Address - Street 1:664 DORCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-3537
Practice Address - Country:US
Practice Address - Phone:910-638-3224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health