Individual provider Active NPI

Mackenzie Obrien, LMHC-D

  • Counselor
  • Albany, NY
National Provider Identifier
1184190969
Registry record updated Apr 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
License
010998 Issued in NY
Practice address
418 Broadway # 7665
Albany, NY 12207-2922
Phone
(585) 481-7305
NPI assigned
Oct 18, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 30, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X P09759 NY
Counselor 101Y00000X 010998 NY Primary

Addresses

Primary practice location

418 Broadway # 7665
Albany, NY 12207-2922

Mailing address

418 Broadway # 7665
Albany, NY 12207-2922
Phone (585) 481-7305

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240605001440 NY Practitioner - Mental Health Counselor 5991247058 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
P09759NYMDCounselor

Practice roles

OrganizationSpecialtyStatusNew patients
Canino LCSW Psychotherapy PC CurrentSince May 29, 2024 Accepting new patients

Locations

68 Jay St
Ste 311
Brooklyn, NY 11201
Phone (347) 560-8591

68 Jay St
Ste 620
Brooklyn, NY 11201
Phone (646) 362-9382

1082 Victory Blvd
Staten Island, NY 10301
Phone (718) 815-3500

Organizations & group practices 1

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": "1539820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745971200000",
    "number": "1184190969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "418 BROADWAY # 7665",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122072922",
            "telephone_number": "585-481-7305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "418 BROADWAY # 7665",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122072922",
            "telephone_number": "585-481-7305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OBRIEN",
        "first_name": "MACKENZIE",
        "credential": "LMHC-D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-10-18",
        "last_updated": "2025-04-30",
        "certification_date": "2025-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NY",
            "license": "P09759",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NY",
            "license": "010998",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albany, NY

Sources for this page

Verify at the official NPI Registry.