Healthcare Provider Details

I. General information

NPI: 1568199354
Provider Name (Legal Business Name): MACKENZIE R NEWMAN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MACKENZIE R BURT LMSW

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 60TH ST SE
KENTWOOD MI
49548-6804
US

IV. Provider business mailing address

950 36TH ST SW
WYOMING MI
49509-3587
US

V. Phone/Fax

Practice location:
  • Phone: 616-538-4120
  • Fax: 616-538-8770
Mailing address:
  • Phone: 616-320-0405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801114916
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: