Provider Demographics
NPI:1477368496
Name:HART, MACKENZIE FAITH (LMSW)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:FAITH
Last Name:HART
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 1:3108 W ROXBURY ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-3856
Mailing Address - Country:US
Mailing Address - Phone:573-301-6064
Mailing Address - Fax:
Practice Address - Street 1:3108 W ROXBURY ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-3856
Practice Address - Country:US
Practice Address - Phone:573-301-6064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024002870104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker