Active NPI
Makenzie Pacocha, LCSW
- Clinical Social Worker
- Philadelphia, PA
National Provider Identifier
1740907575
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- CW023794
- Practice address
- 2517 W Girard Ave
Philadelphia, PA 19130-1313 - Phone
- (267) 704-4133
- NPI assigned
- Oct 24, 2022
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Social Worker | 104100000X | SW137591 | PA | |
| Clinical Social Worker | 1041C0700X | CW023794 | PA | Primary |
Addresses
Primary practice location
2517 W Girard Ave
Philadelphia, PA 19130-1313
Mailing address
2517 W Girard Ave
Philadelphia, PA 19130-1313
Phone (267) 704-4133
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 27, 2024 through Feb 27, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SW137591 | PA | MD | Social Worker |
| CW023794 | PA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1666569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730678400000",
"number": "1740907575",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2517 W GIRARD AVE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191301313",
"telephone_number": "267-704-4133"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2517 W GIRARD AVE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191301313",
"telephone_number": "267-704-4133"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PACOCHA",
"first_name": "MAKENZIE",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-10-24",
"last_updated": "2024-11-04",
"certification_date": "2024-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "PA",
"license": "SW137591",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "PA",
"license": "CW023794",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2024; 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.