Provider Demographics
NPI:1184031858
Name:MCKINNON, SARAH B
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:B
Last Name:MCKINNON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 GRANGE RD
Mailing Address - Street 2:
Mailing Address - City:CHEBEAGUE ISLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04017-3211
Mailing Address - Country:US
Mailing Address - Phone:207-650-9292
Mailing Address - Fax:
Practice Address - Street 1:87 MAIN ST
Practice Address - Street 2:
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-6718
Practice Address - Country:US
Practice Address - Phone:207-650-9292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL4351101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional