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General NPI Number Information
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NPI Number | 1063812527
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Entity Type | Organization
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Legal Business Name | CAROLE MACKENZIE LCSW
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Dates
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Enumeration Date | 09/02/2014
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Last Update Date | 11/04/2014
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Provider Practice Location Address
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Address Line | 674 PROSPECT AVE
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City | HARTFORD
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State | CT
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Zip | 06105-4288
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Country | US
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Telephone | 860-231-7373
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Fax | 860-233-5736
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Provider Business Mailing Address
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Address Line | 674 PROSPECT AVE
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City | HARTFORD
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State | CT
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Zip | 06105-4288
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Country | US
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Telephone | 860-231-7373
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Fax | 860-233-5736
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | PROF. CAROLE HOLABIRD MACKENZIE
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Credential | LCSW
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Telephone | 860-231-7373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 002083
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 002083
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 002083
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License Number State | CT
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