Healthcare Provider Details

I. General information

NPI: 1710501333
Provider Name (Legal Business Name): MACKENZIE PORCELLO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MACKENZIE LAWLER LCSW

II. Dates (important events)

Enumeration Date: 05/29/2020
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 BUCKLAND RD
SOUTH WINDSOR CT
06074-3738
US

IV. Provider business mailing address

27 LONGVIEW RD
ENFIELD CT
06082-4019
US

V. Phone/Fax

Practice location:
  • Phone: 860-543-4584
  • Fax:
Mailing address:
  • Phone: 860-543-4584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number012617
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: