MEDICARE: MS. KARYN A MACKENZIE FAJARDO LCSW, LICSW

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	225700000X	Massage Therapist	MT-26440	AZ
2	225700000X	Massage Therapist	MA-00020322	WA
3	1041C0700X	Clinical Social Worker	LCSW-16710	AZ
4	1041C0700X	Clinical Social Worker	LW60294108	WA
5	171100000X	Acupuncturist	LAC-012200	AZ

General Provider Information

NPI Number	:	1154445062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KARYN A MACKENZIE FAJARDO LCSW, LICSW

Provider Business Mailing Address
First Line	:	8715 W UNION HILLS DR
Second Line	:	STE 111
City	:	PEORIA
State	:	AZ
Zip	:	85382-3031
Country	:	US
Telephone Number	:	425-233-1732
Fax Number	:	623-248-7737

Provider Business Practice Location Address
First Line	:	8715 W UNION HILLS DR STE 111
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-3031
Country	:	US
Telephone Number	:	425-233-1732
Fax Number	:	623-248-7737

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

Provider Enumeration Date	:	03/17/2007
Last Update Date	:	02/12/2026

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