Healthcare Provider Details

I. General information

NPI: 1922885706
Provider Name (Legal Business Name): MACKENZIE A DAVIS LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3147 GLENDALE MILFORD RD
CINCINNATI OH
45241-3134
US

IV. Provider business mailing address

3147 GLENDALE MILFORD RD
CINCINNATI OH
45241-3134
US

V. Phone/Fax

Practice location:
  • Phone: 513-346-1270
  • Fax: 513-346-1243
Mailing address:
  • Phone: 513-346-1270
  • Fax: 513-346-1243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number257857
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2304840-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: