Provider Demographics
NPI:1104902303
Name:MCKENZIE, CATHERINE THERESE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:THERESE
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:LCSW
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Mailing Address - Street 1:201 MECHANIC ST
Mailing Address - Street 2:BLUE GRASS COMP CARE GRATZ PARK CLINIC
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40507
Mailing Address - Country:US
Mailing Address - Phone:859-233-0444
Mailing Address - Fax:859-233-0144
Practice Address - Street 1:201 MECHANIC ST
Practice Address - Street 2:BLUE GRASS COMP CARE GRATZ PARK CLINIC
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40507
Practice Address - Country:US
Practice Address - Phone:859-233-0444
Practice Address - Fax:859-233-0144
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KYKY11331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30615058Medicaid
KY0575134Medicare ID - Type Unspecified