Provider Demographics
NPI:1447967096
Name:MCNAMARA, MACKENZIE (PHD)
Entity type:Individual
Prefix:DR
First Name:MACKENZIE
Middle Name:
Last Name:MCNAMARA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 POINT JUDITH RD # 174
Mailing Address - Street 2:
Mailing Address - City:NARRAGANSETT
Mailing Address - State:RI
Mailing Address - Zip Code:02882-3468
Mailing Address - Country:US
Mailing Address - Phone:401-542-4813
Mailing Address - Fax:
Practice Address - Street 1:91 POINT JUDITH RD # 174
Practice Address - Street 2:
Practice Address - City:NARRAGANSETT
Practice Address - State:RI
Practice Address - Zip Code:02882-3468
Practice Address - Country:US
Practice Address - Phone:401-542-4813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-02
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS02112103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist