Provider Demographics
NPI:1528192945
Name:MACKENZIE, REBECCA BUTLER (LICSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:BUTLER
Last Name:MACKENZIE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 OPERA HOUSE SQUARE
Mailing Address - Street 2:BOX 33
Mailing Address - City:CLAREMONT
Mailing Address - State:NH
Mailing Address - Zip Code:03743-5408
Mailing Address - Country:US
Mailing Address - Phone:603-504-2851
Mailing Address - Fax:
Practice Address - Street 1:24 OPERA HOUSE SQ STE 405
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:NH
Practice Address - Zip Code:03743-5408
Practice Address - Country:US
Practice Address - Phone:603-504-2851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH13621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical