Basic Information
| Provider Information | |||||||||
| NPI: | 1912426677 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MACKENZIE | ||||||||
| FirstName: | HEATHER | ||||||||
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| Credential: | LICSW, LCSW. CADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 28B 5TH ST | ||||||||
| Address2: | |||||||||
| City: | DOVER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038202950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3125933012 | ||||||||
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| Practice Location | |||||||||
| Address1: | 660 CHESTNUT ST | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031043550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036344446 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2017 | ||||||||
| LastUpdateDate: | 10/15/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 26605 | IL | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 149.018300 | IL | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 2230 | NH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.