Active NPI
Connie Kay Mackenzie, LCSW
- Mental Health Counselor
- San Jose, CA
National Provider Identifier
1124427901
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- LCSW 61797
- Practice address
- 440 Mill Pond Dr
San Jose, CA 95125-1406 - Phone
- (408) 499-5469
- NPI assigned
- Aug 18, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LCSW 61797 | CA | Primary |
| Clinical Social Worker | 1041C0700X | LCSW 61797 |
Addresses
Primary practice location
440 Mill Pond Dr
San Jose, CA 95125-1406
Mailing address
PO Box 734
Los Gatos, CA 95031-0734
Phone (408) 499-5469
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Dec 18, 2024 through Dec 18, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCSW 61797 | CA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1408320000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1408320000000",
"number": "1124427901",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 734",
"city": "LOS GATOS",
"state": "CA",
"postal_code": "950310734",
"telephone_number": "408-499-5469"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "440 MILL POND DR",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951251406",
"telephone_number": "408-499-5469"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACKENZIE",
"first_name": "CONNIE",
"middle_name": "KAY",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-08-18",
"last_updated": "2014-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "LCSW 61797",
"primary": true
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": null,
"license": "LCSW 61797",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.