Provider Demographics
NPI:1235987595
Name:MACKENZIE, MARIAH
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:MACKENZIE
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 1:100 INDEPENDENCE DR UNIT 8
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-1898
Mailing Address - Country:US
Mailing Address - Phone:508-778-1839
Mailing Address - Fax:
Practice Address - Street 1:100 INDEPENDENCE DR UNIT 8
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-1898
Practice Address - Country:US
Practice Address - Phone:508-778-1839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health