Provider Demographics
NPI:1922187566
Name:MCKENZIE-ANDERSON, RITA (PHD)
Entity Type:Individual
Prefix:DR
First Name:RITA
Middle Name:
Last Name:MCKENZIE-ANDERSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 UNION ST
Mailing Address - Street 2:SUITE 14
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-4123
Mailing Address - Country:US
Mailing Address - Phone:413-731-1110
Mailing Address - Fax:
Practice Address - Street 1:380 UNION ST
Practice Address - Street 2:SUITE 14
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-4123
Practice Address - Country:US
Practice Address - Phone:413-731-1110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3831103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0519103Medicaid
MAW04382Medicare ID - Type Unspecified