Provider Demographics
NPI:1851894893
Name:MCKENZIE, KARLEO L SR (MSSA, LSW)
Entity Type:Individual
Prefix:MR
First Name:KARLEO
Middle Name:L
Last Name:MCKENZIE
Suffix:SR
Gender:M
Credentials:MSSA, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4872 LINDSEY LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2928
Mailing Address - Country:US
Mailing Address - Phone:216-288-0386
Mailing Address - Fax:
Practice Address - Street 1:34900 CHARDON RD STE 200
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY HILLS
Practice Address - State:OH
Practice Address - Zip Code:44094-9161
Practice Address - Country:US
Practice Address - Phone:440-951-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS1450845104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHS1450845OtherSOCIAL WORK LICENSE NUMBER