# CAROLE MACKENZIE LCSW

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063812527
- **Authorized official:** PROF. CAROLE HOLABIRD MACKENZIE LCSW (LICENSED CLINICAL SOCIAL WORKER)
- **Authorized official phone:** (860) 231-7373

## Contact information

- **Practice address:** 674 PROSPECT AVE, HARTFORD, CT 06105-4288
- **Practice address phone:** (860) 231-7373
- **Practice address fax:** (860) 233-5736
- **Mailing address:** 674 PROSPECT AVE, HARTFORD, CT 06105-4288
- **Mailing address phone:** (860) 231-7373
- **Mailing address fax:** (860) 233-5736

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | 002083 | CT | — |
| 261QM0850X | Adult Mental Health Clinic/Center | 002083 | CT | — |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | 002083 | CT | Yes |

## Other

- **Enumeration date:** 09/02/2014
- **Last updated:** 11/04/2014