Provider Demographics
NPI:1124473897
Name:MCKENZIE, KAREN K (LICSW)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:K
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:M
Other - Last Name:KILLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:25 THURBER BLVD. UNIT #2
Mailing Address - Street 2:PRO-ABILITY
Mailing Address - City:SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02917
Mailing Address - Country:US
Mailing Address - Phone:401-233-1634
Mailing Address - Fax:401-233-1674
Practice Address - Street 1:25 THURBER BLVD. UNIT #2
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02917
Practice Address - Country:US
Practice Address - Phone:401-233-1634
Practice Address - Fax:401-233-1674
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-29
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW010571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical