Provider Demographics
NPI:1073362968
Name:KRUGER, MACKENZIE (LMSW)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:KRUGER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:MACKENZIE
Other - Middle Name:LYN
Other - Last Name:KRUGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:400 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14213-1207
Mailing Address - Country:US
Mailing Address - Phone:716-816-2302
Mailing Address - Fax:
Practice Address - Street 1:400 FOREST AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14213-1207
Practice Address - Country:US
Practice Address - Phone:716-816-2302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker