Provider Demographics
NPI:1467685347
Name:MCKENZIE, JEFF D (LMHC)
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:D
Last Name:MCKENZIE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 HUDSON AVE
Mailing Address - Street 2:
Mailing Address - City:MECHANICVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12118-4503
Mailing Address - Country:US
Mailing Address - Phone:518-435-9931
Mailing Address - Fax:
Practice Address - Street 1:500 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-2213
Practice Address - Country:US
Practice Address - Phone:518-435-9931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-26
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18 P68132101YM0800X
NY005267101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health