Provider Demographics
NPI:1184416406
Name:DONNELLY, MACKENZIE PAYTON (LCSW)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:PAYTON
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 MACKAY AVE
Mailing Address - Street 2:
Mailing Address - City:WALDWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:07463-1910
Mailing Address - Country:US
Mailing Address - Phone:201-786-8740
Mailing Address - Fax:201-786-8740
Practice Address - Street 1:36 MACKAY AVE
Practice Address - Street 2:
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463-1910
Practice Address - Country:US
Practice Address - Phone:201-786-8740
Practice Address - Fax:201-786-8740
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0981961041C0700X
NJ44SC064858001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical