Provider Demographics
NPI:1154914034
Name:REED, MCKENZIE (LICSW)
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:
Last Name:REED
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 1:21 FATHER DEVALLES BLVD
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02723-1519
Mailing Address - Country:US
Mailing Address - Phone:774-301-3737
Mailing Address - Fax:
Practice Address - Street 1:21 FATHER DEVALLES BLVD
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02723-1519
Practice Address - Country:US
Practice Address - Phone:774-301-3737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2237741041C0700X
MA1240921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical