Healthcare Provider Details

I. General information

NPI: 1023381639
Provider Name (Legal Business Name): MARVA JOY MCKENZIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2012
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2840 SW 3RD AVE
MIAMI FL
33129-2317
US

IV. Provider business mailing address

2840 SW 3RD AVE
MIAMI FL
33129-2317
US

V. Phone/Fax

Practice location:
  • Phone: 305-857-0050
  • Fax: 305-854-4948
Mailing address:
  • Phone: 305-857-0050
  • Fax: 305-854-4948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT2626
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: