Healthcare Provider Details

I. General information

NPI: 1093147381
Provider Name (Legal Business Name): MAKENZIE LEE GALLEGO MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAKENZIE LEE BROWN-HARRIS

II. Dates (important events)

Enumeration Date: 08/08/2013
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1299 BRYANT AVE
MOUNTAIN VIEW CA
94040-4527
US

IV. Provider business mailing address

201 ALMOND AVE
LOS ALTOS CA
94022-2206
US

V. Phone/Fax

Practice location:
  • Phone: 650-960-8485
  • Fax:
Mailing address:
  • Phone: 650-960-8485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number91987
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW91987
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: