Provider Demographics
NPI:1205503240
Name:MCKENZIE, TANISHA (BCBA)
Entity type:Individual
Prefix:MS
First Name:TANISHA
Middle Name:
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 LAMARR AVE
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-1244
Mailing Address - Country:US
Mailing Address - Phone:347-232-9067
Mailing Address - Fax:
Practice Address - Street 1:1209A E 93RD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3928
Practice Address - Country:US
Practice Address - Phone:347-232-9067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003450103K00000X
NY0-21-11714106E00000X
NY000045-01106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst