Healthcare Provider Details

I. General information

NPI: 1821929977
Provider Name (Legal Business Name): MACKENZIE STABILE LP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1485 S COUNTY TRL UNIT 107
EAST GREENWICH RI
02818-1771
US

IV. Provider business mailing address

1485 S COUNTY TRL UNIT 107
EAST GREENWICH RI
02818-1771
US

V. Phone/Fax

Practice location:
  • Phone: 401-785-0040
  • Fax:
Mailing address:
  • Phone: 401-785-0040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS02453
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: