Provider Demographics
NPI:1093147381
Name:GALLEGO, MAKENZIE LEE (MSW)
Entity Type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:LEE
Last Name:GALLEGO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:MAKENZIE
Other - Middle Name:LEE
Other - Last Name:BROWN-HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10301 VISTA DR
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-2040
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1309 S MARY AVE
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-3050
Practice Address - Country:US
Practice Address - Phone:408-252-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA919871041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool