Healthcare Provider Details

I. General information

NPI: 1952083388
Provider Name (Legal Business Name): MACKENZIE KUHL LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2023
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 PROSPECT ST
MIDLAND PARK NJ
07432-1343
US

IV. Provider business mailing address

20 W HOLLY ST APT 15
CRANFORD NJ
07016-2174
US

V. Phone/Fax

Practice location:
  • Phone: 201-249-2793
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL06541200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: