Provider Demographics
NPI:1811270374
Name:MACKENZIE, KAREN LOUISE
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:LOUISE
Last Name:MACKENZIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 8TH ST
Mailing Address - Street 2:#712
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-4208
Mailing Address - Country:US
Mailing Address - Phone:617-398-6500
Mailing Address - Fax:
Practice Address - Street 1:197 8TH ST
Practice Address - Street 2:#712
Practice Address - City:CHARLESTOWN
Practice Address - State:MA
Practice Address - Zip Code:02129-4208
Practice Address - Country:US
Practice Address - Phone:617-398-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker