Provider Demographics
NPI:1154445062
Name:MACKENZIE FAJARDO, KARYN A (LCSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:KARYN
Middle Name:A
Last Name:MACKENZIE FAJARDO
Suffix:
Gender:F
Credentials:LCSW, LICSW
Other - Prefix:
Other - First Name:KARYN
Other - Middle Name:ANNE
Other - Last Name:MACKENZIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:8715 W UNION HILLS DR
Mailing Address - Street 2:STE 111
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-3031
Mailing Address - Country:US
Mailing Address - Phone:425-233-1732
Mailing Address - Fax:623-248-7737
Practice Address - Street 1:8715 W UNION HILLS DR STE 111
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-3031
Practice Address - Country:US
Practice Address - Phone:425-233-1732
Practice Address - Fax:623-248-7737
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-26440225700000X
WAMA-00020322225700000X
AZLCSW-167101041C0700X
WALW602941081041C0700X
AZLAC-012200171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No171100000XOther Service ProvidersAcupuncturist