Provider Demographics
NPI:1992443907
Name:ZDANOWITZ, MACKENZIE (LLMSW)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:ZDANOWITZ
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3679 LOSEY RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49272-9639
Mailing Address - Country:US
Mailing Address - Phone:517-745-9931
Mailing Address - Fax:
Practice Address - Street 1:2536 SPRING ARBOR RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-3602
Practice Address - Country:US
Practice Address - Phone:517-998-0999
Practice Address - Fax:517-998-0998
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511148071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical