Provider Demographics
NPI:1568205748
Name:WARDEN, MACKENZIE RAE (MS, NCC)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:RAE
Last Name:WARDEN
Suffix:
Gender:F
Credentials:MS, NCC
Other - Prefix:
Other - First Name:MACKENZIE
Other - Middle Name:RAE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 W COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-2824
Mailing Address - Country:US
Mailing Address - Phone:814-325-0280
Mailing Address - Fax:
Practice Address - Street 1:1200 W COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-2824
Practice Address - Country:US
Practice Address - Phone:814-325-0280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAPC000105101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health