Provider Demographics
NPI:1972702488
Name:MCKENZIE, HEIDI J (LMFT, PSYD)
Entity type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:J
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:LMFT, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4232 NORTHERN PIKE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2732
Mailing Address - Country:US
Mailing Address - Phone:412-663-0062
Mailing Address - Fax:
Practice Address - Street 1:4232 NORTHERN PIKE
Practice Address - Street 2:SUITE 201
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2732
Practice Address - Country:US
Practice Address - Phone:412-663-0062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2011-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40336106H00000X
PAPS016702103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1024635790001Medicaid