Provider Demographics
NPI:1013017771
Name:MCKENNA, NANCY C
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:C
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:C
Other - Last Name:O'BYRNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:33 BENDER LN
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-4321
Mailing Address - Country:US
Mailing Address - Phone:518-527-0099
Mailing Address - Fax:518-439-4662
Practice Address - Street 1:747 MADISON AVE STE 2
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3392
Practice Address - Country:US
Practice Address - Phone:518-755-0611
Practice Address - Fax:518-755-0611
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR056814-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical