Individual
MCKENZIE BOURQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3550 MARKET ST, PHILADELPHIA, PA 19104-3329
(267) 624-3493
Mailing address
2226 S MILDRED ST, PHILADELPHIA, PA 19148-3110
(518) 207-5432
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PS019921
PA
Other
Enumeration date
06/28/2023
Last updated
06/28/2023
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