Provider Demographics
NPI:1922885706
Name:DAVIS, MACKENZIE A (LISW)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:A
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3147 GLENDALE MILFORD RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-3134
Mailing Address - Country:US
Mailing Address - Phone:513-346-1270
Mailing Address - Fax:513-346-1243
Practice Address - Street 1:3147 GLENDALE MILFORD RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-3134
Practice Address - Country:US
Practice Address - Phone:513-346-1270
Practice Address - Fax:513-346-1243
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-13
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2578571041C0700X
OHI.2304840-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical