Individual provider Active NPI

Demetria Trinnette McKenzie, MSW

  • Clinical Social Worker
  • Stamford, CT
National Provider Identifier
1316035298
Registry record updated Dec 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
60 Palmers Hill Road
Stamford, CT 06902
Phone
(203) 324-3167
Fax
(203) 358-2327
NPI assigned
Oct 10, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X Primary

Addresses

Primary practice location

60 Palmers Hill Road
Stamford, CT 06902

Mailing address

20 Bridge St
Greenwich, CT 06830-5238
Phone (203) 629-2822

Other identifiers 1

IdentifierTypeStateIssuer
004172920MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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 1

Enrollment IDStateProvider typePAC IDDetails
I20251226001711 CT Practitioner - Clinical Social Worker 1850887019 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southbury Adolescent and Young Adult Counseling CenterGroup PAC ID 5193221349, 15 clinicians

Practice addresses (Care Compare)

519 Heritage Rd
Suite 2A5
Southbury, CT 06488-6694
Phone (203) 568-5923

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Southbury Adolescent and Young Adult Counseling Center Clinical CurrentSince Dec 1, 2025 Accepting new patients

Locations

519 Heritage Rd
Ste 2A5
Southbury, CT 06488
Phone (203) 568-5923

26 N Main St
Ste 2A
Southington, CT 06489
Phone (203) 568-5923

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": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765929600000",
    "number": "1316035298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 BRIDGE ST",
            "city": "GREENWICH",
            "state": "CT",
            "postal_code": "068305238",
            "telephone_number": "203-629-2822",
            "fax_number": "203-629-2940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 PALMERS HILL ROAD",
            "city": "STAMFORD",
            "state": "CT",
            "postal_code": "06902",
            "telephone_number": "203-324-3167",
            "fax_number": "203-358-2327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKENZIE",
        "first_name": "DEMETRIA",
        "middle_name": "TRINNETTE",
        "credential": "MSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-10",
        "last_updated": "2025-12-17",
        "certification_date": "2025-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004172920",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stamford, CT

Sources for this page

Verify at the official NPI Registry.