Provider Demographics
NPI:1649299132
Name:MCKENZIE, RODERICK FORBES II (LPN, LADCII, CCDN)
Entity type:Individual
Prefix:MR
First Name:RODERICK
Middle Name:FORBES
Last Name:MCKENZIE
Suffix:II
Gender:M
Credentials:LPN, LADCII, CCDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 HARBOR VIEW CT
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-3031
Mailing Address - Country:US
Mailing Address - Phone:978-283-8712
Mailing Address - Fax:
Practice Address - Street 1:298 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-4832
Practice Address - Country:US
Practice Address - Phone:978-283-4001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1998101YA0400X
MA34075164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered164W00000XNursing Service ProvidersLicensed Practical Nurse