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General NPI Number Information
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NPI Number | 1851894893
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Entity Type | Individual
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Provider Name | KARLEO L. MCKENZIE SR. MSSA, LSW
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Gender | Male
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Dates
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Enumeration Date | 03/15/2018
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Last Update Date | 03/15/2018
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Provider Practice Location Address
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Address Line | 34900 CHARDON RD STE 200
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City | WILLOUGHBY HILLS
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State | OH
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Zip | 44094-9161
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Country | US
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Telephone | 440-951-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 4872 LINDSEY LN
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City | RICHMOND HEIGHTS
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State | OH
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Zip | 44143-2928
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Country | US
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Telephone | 216-288-0386
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | S1450845
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License Number State | OH
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