Provider Demographics
NPI:1669142196
Name:MACKENZIE FAMILY THERAPY PLLC
Entity type:Organization
Organization Name:MACKENZIE FAMILY THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:203-722-5152
Mailing Address - Street 1:3 W END AVE
Mailing Address - Street 2:
Mailing Address - City:OLD GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06870-1640
Mailing Address - Country:US
Mailing Address - Phone:203-722-5152
Mailing Address - Fax:
Practice Address - Street 1:3 W END AVE
Practice Address - Street 2:
Practice Address - City:OLD GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06870-1640
Practice Address - Country:US
Practice Address - Phone:203-722-5152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty