Active NPI
Mackenzie Fezza
- Clinical Social Worker
- St Augustine, FL
National Provider Identifier
1407796600
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- Practice address
- 33 Bethesda CT
St Augustine, FL 32084-0159 - Phone
- (732) 552-9242
- NPI assigned
- Mar 30, 2026
- Last updated
- Mar 30, 2026
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | Primary |
Addresses
Primary practice location
33 Bethesda CT
St Augustine, FL 32084-0159
Mailing address
33 Bethesda CT
St Augustine, FL 32084-0159
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 13, 2026 through Jul 13, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1774828800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1774828800000",
"number": "1407796600",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "33 BETHESDA CT",
"city": "ST AUGUSTINE",
"state": "FL",
"postal_code": "320840159"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "33 BETHESDA CT",
"city": "ST AUGUSTINE",
"state": "FL",
"postal_code": "320840159",
"telephone_number": "732-552-9242"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FEZZA",
"first_name": "MACKENZIE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2026-03-30",
"last_updated": "2026-03-30",
"certification_date": "2026-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Augustine, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2026; 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.