Provider Demographics
NPI:1528248374
Name:MACKENZIE, JANICE D
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:D
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 1:215 MYRTLE ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-4354
Mailing Address - Country:US
Mailing Address - Phone:603-668-0014
Mailing Address - Fax:603-623-7676
Practice Address - Street 1:633 THIRD AVE
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NH
Practice Address - Zip Code:03570-1658
Practice Address - Country:US
Practice Address - Phone:603-752-1325
Practice Address - Fax:603-752-6174
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH13951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHIN PROCESSOtherBHN/BC/BS
NHIN PROCESSOtherFIRST HEALTH/COVENTRY
NHIN PROCESSOtherPACIFICARE
NHIN PROCESSMedicaid