Individual provider Active NPI

Kelly Marie Mackenzie, PHD

  • Clinical Psychologist
  • Trenton, NJ
National Provider Identifier
1043831100
Registry record updated Jul 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
35SI00780000 Issued in NJ
Practice address
832 Brunswick Ave
Trenton, NJ 08638-3847
Phone
(609) 815-7400
NPI assigned
Apr 29, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 390200000X PA
Clinical Psychologist 103TC0700X 35SI00780000 NJ Primary

Addresses

Primary practice location

832 Brunswick Ave
Trenton, NJ 08638-3847

Mailing address

832 Brunswick Ave
Trenton, NJ 08638-3847
Phone (609) 815-7400

Other practice location 1

Geisinger Medical Center 100 North Academy Avenue
Danville, PA 17822-0001
Phone (570) 271-6211

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kelly.mackenzie.1@12833.direct.athenahealth.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, NJ2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230814001349 PA Practitioner - Clinical Psychologist 0244692895 Reassigns benefits to 1 organization
I20250729003238 NJ Practitioner - Clinical Psychologist 0244692895 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Capital Health Medical GroupGroup PAC ID 7618264532, 442 clinicians

Practice addresses (Care Compare)

832 Brunswick Ave
Trenton, NJ 08638-3847
Phone (609) 815-7400

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
390200000XPAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Geisinger Clinic CurrentSince Jul 17, 2023 Accepting new patients
Geisinger Clinic CurrentSince Jul 17, 2023 Accepting new patients
Geisinger Clinic Current Accepting new patients
Capital Health Multispecialty Group CurrentSince Aug 1, 2025 Accepting new patients
Capital Health Medical Group CurrentSince Aug 1, 2025 Accepting new patients

Locations

3131 Princeton Pike
Bldg 5
Lawrenceville, NJ 08648
Phone (609) 844-9661

1 Capital Way
Pennington, NJ 08534
Phone (609) 303-4000

750 Brunswick Ave
Trenton, NJ 08638
Phone (609) 394-6000

832 Brunswick Ave
Trenton, NJ 08638
Phone (609) 396-2600

100 N Academy Ave
Danville, PA 17822

27 Cjems Ln
Ste 4
Mifflintown, PA 17059
Phone (717) 436-0129

Interoperability endpoints

  • Direct secure messaging: kelly.mackenzie.1@12833.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/12833/brand/1/csg/1/fhir/r4

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1588118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752710400000",
    "number": "1043831100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "832 BRUNSWICK AVE",
            "city": "TRENTON",
            "state": "NJ",
            "postal_code": "086383847",
            "telephone_number": "609-815-7400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "832 BRUNSWICK AVE",
            "city": "TRENTON",
            "state": "NJ",
            "postal_code": "086383847",
            "telephone_number": "609-815-7400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Geisinger Medical Center 100 North Academy Avenue",
            "address_purpose": "LOCATION",
            "city": "Danville",
            "state": "PA",
            "postal_code": "178220001",
            "country_code": "US",
            "telephone_number": "570-271-6211",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MACKENZIE",
        "first_name": "KELLY",
        "middle_name": "MARIE",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-29",
        "last_updated": "2025-07-17",
        "certification_date": "2025-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PA",
            "license": "390200000X",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NJ",
            "license": "35SI00780000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kelly.mackenzie.1@12833.direct.athenahealth.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "832 Brunswick Ave",
            "city": "Trenton",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "086383847",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Trenton, NJ

Sources for this page

Verify at the official NPI Registry.