Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 035043 | NY |
NPI | 1003093238 |
---|---|
Provider Name | Mr. Peter Joseph Mckenzie |
First Address | Centereach, NY 11720-2135 |
Second Address | Centereach, NY 11720-2135 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2008 |
Last Update Date | 30/01/2008 |