MEDICARE: MACKENZIE SMITH

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	1041C0700X	Clinical Social Worker	16368	CT

General Provider Information

NPI Number	:	1558918862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MACKENZIE SMITH

Provider Business Mailing Address
First Line	:	12 TREFOIL RD
Second Line	:
City	:	OXFORD
State	:	CT
Zip	:	06478-1661
Country	:	US
Telephone Number	:	203-206-9352
Fax Number	:

Provider Business Practice Location Address
First Line	:	137 WATER ST
Second Line	:
City	:	TORRINGTON
State	:	CT
Zip	:	06790-5339
Country	:	US
Telephone Number	:	203-558-3975
Fax Number	:

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

Provider Enumeration Date	:	08/21/2019
Last Update Date	:	03/03/2026

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Directions to “ MACKENZIE SMITH ” Practice Location

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