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General NPI Number Information
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NPI Number | 1790969921
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Entity Type | Individual
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Provider Name | SALLY MACKENZIE MS, MSW
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Gender | Female
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Dates
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Enumeration Date | 12/24/2007
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Last Update Date | 12/24/2007
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Provider Practice Location Address
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Address Line | CALLE PLAZA SANTA CRUZ AN 6 ENCANTADA ANTILLANA
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City | TRUJILLO ALTO
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State | PR
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Zip | 00976
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Country | US
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Telephone | 787-760-4960
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Fax |
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Provider Business Mailing Address
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Address Line | CALLE PLAZA SANTA CRUZ AN 6 ENCANTADA ANTILLANA
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City | TRUJILLO ALTO
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State | PR
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Zip | 00976
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Country | US
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Telephone | 787-760-4960
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 9305
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License Number State | PR
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