Provider Demographics
NPI:1730441395
Name:MCKENZIE, DEBRA MAXIAME
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:MAXIAME
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 PARKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-1506
Mailing Address - Country:US
Mailing Address - Phone:718-675-1249
Mailing Address - Fax:718-675-1267
Practice Address - Street 1:670 PARKSIDE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-1506
Practice Address - Country:US
Practice Address - Phone:718-675-1249
Practice Address - Fax:718-675-1267
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator