Provider Demographics
NPI:1699947358
Name:MCKENZIE, BROOKE DANIELLE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:DANIELLE
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:DANIELLE
Other - Last Name:DONALDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:224 TWIN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-7727
Mailing Address - Country:US
Mailing Address - Phone:814-443-3639
Mailing Address - Fax:814-443-2737
Practice Address - Street 1:224 TWIN LAKE RD
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-7727
Practice Address - Country:US
Practice Address - Phone:814-443-3639
Practice Address - Fax:814-443-2737
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW125414104100000X
PACW0162981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker