Provider Demographics
NPI:1982475646
Name:HALADYNA, MACKENZIE M
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:M
Last Name:HALADYNA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 PARK PLACE DR STE 108
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-2068
Mailing Address - Country:US
Mailing Address - Phone:724-300-8028
Mailing Address - Fax:
Practice Address - Street 1:3000 PLACE PARK DRIVE, WASHINGTON
Practice Address - Street 2:
Practice Address - City:SUITE 108
Practice Address - State:PA
Practice Address - Zip Code:15301
Practice Address - Country:US
Practice Address - Phone:724-300-8028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health