Provider Demographics
NPI:1730689035
Name:MCKENZIE, ANGELICA DENISE (LMHC)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:DENISE
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2506 FERCHEN ST
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-4608
Mailing Address - Country:US
Mailing Address - Phone:516-509-2228
Mailing Address - Fax:
Practice Address - Street 1:2506 FERCHEN ST
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-4608
Practice Address - Country:US
Practice Address - Phone:516-509-2228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-14
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008472-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health