Mackenzie Wallis, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW13508 Issued in FL

Practice address

2355 Salzedo St Ste 311
Coral Gables, FL 33134-5061

Phone

(719) 321-2790

NPI assigned

Apr 11, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1523404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523404800000",
    "number": "1275030611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7540 SW 59TH CT APT 8",
            "city": "SOUTH MIAMI",
            "state": "FL",
            "postal_code": "331435147",
            "telephone_number": "719-321-2790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2355 SALZEDO ST STE 311",
            "city": "CORAL GABLES",
            "state": "FL",
            "postal_code": "331345061",
            "telephone_number": "719-321-2790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLIS",
        "first_name": "MACKENZIE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-04-11",
        "last_updated": "2018-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW13508",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walk Physical Therapy PA
• Dominique Walker
• Jamell Edwina Walker, M.D.
• Anthony Wallace, MASTER
• Brittany Wallis, LMFT
• Isabella Dawn Walls
• Kenneth T Wals, MD
• Emily Ann Walsh, M.S.
• Kathleen Diana Warman, PSY.D.
• Teresita H. Washington, PHARMD

• Clinical Social Worker in Coral Gables, FL
• Providers in Coral Gables, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.