MEDICARE: REBECCA BUTLER MACKENZIE LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	1362	NH

General Provider Information

NPI Number	:	1528192945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA BUTLER MACKENZIE LICSW

Provider Business Mailing Address
First Line	:	24 OPERA HOUSE SQUARE
Second Line	:	BOX 33
City	:	CLAREMONT
State	:	NH
Zip	:	03743-5408
Country	:	US
Telephone Number	:	603-504-2851
Fax Number	:

Provider Business Practice Location Address
First Line	:	24 OPERA HOUSE SQ STE 405
Second Line	:
City	:	CLAREMONT
State	:	NH
Zip	:	03743-5408
Country	:	US
Telephone Number	:	603-504-2851
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	01/31/2024

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