Provider Demographics
NPI:1942359187
Name:MCKENZIE, AIDZA Y (PHD)
Entity Type:Individual
Prefix:
First Name:AIDZA
Middle Name:Y
Last Name:MCKENZIE
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 1:108 RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01035-9595
Mailing Address - Country:US
Mailing Address - Phone:413-387-0075
Mailing Address - Fax:413-387-0074
Practice Address - Street 1:108 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01035-9595
Practice Address - Country:US
Practice Address - Phone:413-387-0075
Practice Address - Fax:413-387-0074
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8152103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW10610OtherBLUE CROSS PROVIDER NUMBE
MAW51251Medicare ID - Type UnspecifiedPROVIDER NUMBER