Provider Demographics
NPI:1750034641
Name:MCKENZIE, BRANDON J (MS)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:J
Last Name:MCKENZIE
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 BERKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:RI
Mailing Address - Zip Code:02871-5503
Mailing Address - Country:US
Mailing Address - Phone:401-543-4253
Mailing Address - Fax:
Practice Address - Street 1:1082 DAVOL ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-1124
Practice Address - Country:US
Practice Address - Phone:508-678-2833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor