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General NPI Number Information
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NPI Number | 1932434685
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Entity Type | Individual
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Provider Name | LYNNETTE D MACKENZIE PSYD
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Gender | Female
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Dates
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Enumeration Date | 10/14/2009
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Last Update Date | 12/14/2009
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Provider Practice Location Address
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Address Line | 4625 E BAY DR 302
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City | CLEARWATER
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State | FL
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Zip | 33764-5738
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Country | US
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Telephone | 727-412-8000
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Fax | 866-469-3880
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Provider Business Mailing Address
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Address Line | 735 ARLINGTON AVE N 305
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City | ST PETERSBURG
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State | FL
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Zip | 33701-3652
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Country | US
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Telephone | 727-412-8003
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Fax | 866-469-3880
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY7984
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License Number State | FL
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