Provider Demographics
NPI:1235751744
Name:MCKENNA, JAMES FRANCIS (MED, LADC1)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:FRANCIS
Last Name:MCKENNA
Suffix:
Gender:M
Credentials:MED, LADC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 E MAIN RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-4988
Mailing Address - Country:US
Mailing Address - Phone:401-608-3322
Mailing Address - Fax:401-608-3323
Practice Address - Street 1:58 E MAIN RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-4988
Practice Address - Country:US
Practice Address - Phone:401-608-3322
Practice Address - Fax:401-608-3323
Is Sole Proprietor?:No
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA919101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)