Provider Demographics
NPI:1053034991
Name:KEEFE, MACKENZIE (PSYD)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:KEEFE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 OLDE NOAH HUNT RD
Mailing Address - Street 2:
Mailing Address - City:MILLSTONE TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08510-2116
Mailing Address - Country:US
Mailing Address - Phone:609-384-0959
Mailing Address - Fax:
Practice Address - Street 1:970 NJ ROUTE 70
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724
Practice Address - Country:US
Practice Address - Phone:732-784-0983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34692103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical