Provider Demographics
NPI:1750463097
Name:HALKER, MACKENZIE ANNE (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:MACKENZIE
Middle Name:ANNE
Last Name:HALKER
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 ALBERTA DR STE 211
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-1814
Mailing Address - Country:US
Mailing Address - Phone:716-837-6705
Mailing Address - Fax:
Practice Address - Street 1:315 ALBERTA DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1814
Practice Address - Country:US
Practice Address - Phone:716-837-6705
Practice Address - Fax:716-837-6759
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR069739-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00069739-1Medicaid