Provider Demographics
NPI:1124706924
Name:FRED, MACKENZIE TAYLOR (LMSW)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:TAYLOR
Last Name:FRED
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 S CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-2740
Mailing Address - Country:US
Mailing Address - Phone:845-202-3138
Mailing Address - Fax:
Practice Address - Street 1:83 S CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-2740
Practice Address - Country:US
Practice Address - Phone:845-202-3138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
NY1202181041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool