Provider Demographics
NPI:1902576093
Name:WHITE, MAKENZIE KINCAID (LSW, MPH)
Entity Type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:KINCAID
Last Name:WHITE
Suffix:
Gender:F
Credentials:LSW, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 OWENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15227-1934
Mailing Address - Country:US
Mailing Address - Phone:203-747-0655
Mailing Address - Fax:
Practice Address - Street 1:623 CENTER AVE STE 100
Practice Address - Street 2:
Practice Address - City:WEST VIEW
Practice Address - State:PA
Practice Address - Zip Code:15229-1809
Practice Address - Country:US
Practice Address - Phone:412-552-3737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW136832104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker