Provider Demographics
NPI:1588327886
Name:COMANDA, MACKENZIE (LMSW)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:COMANDA
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 1:9309 ELGIN LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-7004
Mailing Address - Country:US
Mailing Address - Phone:240-812-2926
Mailing Address - Fax:
Practice Address - Street 1:2057 PULASKI HWY
Practice Address - Street 2:
Practice Address - City:NORTH EAST
Practice Address - State:MD
Practice Address - Zip Code:21901-3744
Practice Address - Country:US
Practice Address - Phone:443-877-4044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25726104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker