| Doctor Name: | DR. PETER KENNETH MACKENZIE |
| NPI Number: | 1184680290 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | 012093-1 |
| Business Practice Address: | 85 Union St Suite 206 Spencerport, NY - 145591255 |
| Business Phone Number: | 5853492656 |
| Business Fax Number: | 5853525700 |
| Mailing Address: | 85 Union St, Suite 206 SPENCERPORT |
| State: | NY |
| Postal Code: | 145591255 |
| Phone Number: | 5853492656 |
| Fax Number: | 5853525700 |
| NPI Enumeration Date: | 04/26/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 012093-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |