Healthcare Provider Details

I. General information

NPI: 1558918862
Provider Name (Legal Business Name): MACKENZIE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 WATER ST
TORRINGTON CT
06790-5339
US

IV. Provider business mailing address

12 TREFOIL RD
OXFORD CT
06478-1661
US

V. Phone/Fax

Practice location:
  • Phone: 203-558-3975
  • Fax:
Mailing address:
  • Phone: 203-206-9352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number16368
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: