Basic Information
| Provider Information | |||||||||
| NPI: | 1285715334 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCKENZIE | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | WILLIAM | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MSW, LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 MAPLE STREET | ||||||||
| Address2: | CHILD GUIDANCE CLINIC | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137327419 | ||||||||
| FaxNumber: | 4137811059 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 MAPLE STREET | ||||||||
| Address2: | CHILD GUIDANCE CLINIC | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137327419 | ||||||||
| FaxNumber: | 4137811059 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 1021852 | MA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.