Healthcare Provider Details

I. General information

NPI: 1184190969
Provider Name (Legal Business Name): MACKENZIE OBRIEN LMHC-D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2018
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 BROADWAY # 7665
ALBANY NY
12207-2922
US

IV. Provider business mailing address

418 BROADWAY # 7665
ALBANY NY
12207-2922
US

V. Phone/Fax

Practice location:
  • Phone: 585-481-7305
  • Fax:
Mailing address:
  • Phone: 585-481-7305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberP09759
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number010998
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: