Provider Demographics
NPI:1346924321
Name:ROY, MACKENZIE KAYLEN (LMSW)
Entity Type:Individual
Prefix:MISS
First Name:MACKENZIE
Middle Name:KAYLEN
Last Name:ROY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MACKENZIE
Other - Middle Name:KAYLEN
Other - Last Name:ROY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:7414 SAWYER RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323-4717
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7414 SAWYER RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NY
Practice Address - Zip Code:13323-4717
Practice Address - Country:US
Practice Address - Phone:315-601-4461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY114327104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker