Provider Demographics
NPI:1912511338
Name:DONOVAN-MACKENZIE, KATHY (LMSW)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:DONOVAN-MACKENZIE
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 1:722 W BEECH ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-2806
Mailing Address - Country:US
Mailing Address - Phone:516-874-6456
Mailing Address - Fax:
Practice Address - Street 1:2-12 W PARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-2025
Practice Address - Country:US
Practice Address - Phone:516-889-7382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106754104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker