MEDICARE: ADRINE AMOY MCKENZIE PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PY7664	FL

General Provider Information

NPI Number	:	1770465940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRINE AMOY MCKENZIE PH.D.

Provider Business Mailing Address
First Line	:	1931 CORDOVA RD # 138
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-2157
Country	:	US
Telephone Number	:	954-681-1658
Fax Number	:

Provider Business Practice Location Address
First Line	:	1107 SE 4TH AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-1119
Country	:	US
Telephone Number	:	954-681-1658
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2025
Last Update Date	:	07/21/2025

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