Provider Demographics
NPI:1013516830
Name:MCKENZIE, AMORA R (LMSW)
Entity type:Individual
Prefix:
First Name:AMORA
Middle Name:R
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEADOWLANDS PKWY STE 408
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-2901
Mailing Address - Country:US
Mailing Address - Phone:917-583-2394
Mailing Address - Fax:
Practice Address - Street 1:860 MELROSE AVE # 2L
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-4443
Practice Address - Country:US
Practice Address - Phone:917-473-6996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY110118104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY110118Medicaid