Provider Demographics
NPI:1336317932
Name:MACKENZIE, LORI A (LMHC)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:A
Last Name:MACKENZIE
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 1:261 NEWBURY ST
Mailing Address - Street 2:#37
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-7459
Mailing Address - Country:US
Mailing Address - Phone:978-535-2140
Mailing Address - Fax:
Practice Address - Street 1:261 NEWBURY ST
Practice Address - Street 2:#37
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-7459
Practice Address - Country:US
Practice Address - Phone:978-535-2140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5167101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health