Basic Information
| Provider Information | |||||||||
| NPI: | 1154879450 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCKENZIE | ||||||||
| FirstName: | BRANDI | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22811 GREATER MACK AVE | ||||||||
| Address2: | SUITE 111 | ||||||||
| City: | SAINT CLAIR SHORES | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480802021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5863352006 | ||||||||
| FaxNumber: | 5862793886 | ||||||||
| Practice Location | |||||||||
| Address1: | 703 LIVERNOIS ST | ||||||||
| Address2: | |||||||||
| City: | FERNDALE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482202306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2489553219 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2016 | ||||||||
| LastUpdateDate: | 09/28/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6801097351 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 6801097351 | MI | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.