Provider Demographics
NPI:1083138796
Name:MCKEAN, EMMA IRWIN (LCSW)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:IRWIN
Last Name:MCKEAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:ELIZABETH
Other - Last Name:IRWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:358 STILES AVE STE B
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4012
Mailing Address - Country:US
Mailing Address - Phone:904-264-8311
Mailing Address - Fax:904-264-8377
Practice Address - Street 1:358 STILES AVE STE B
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4012
Practice Address - Country:US
Practice Address - Phone:904-264-8311
Practice Address - Fax:042-648-3779
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW146911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14691OtherOTHER