Provider Demographics
NPI:1396830469
Name:MCKINNON, KATHLEEN E (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:E
Last Name:MCKINNON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-7006
Mailing Address - Country:US
Mailing Address - Phone:978-542-0283
Mailing Address - Fax:978-923-0420
Practice Address - Street 1:298 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-4832
Practice Address - Country:US
Practice Address - Phone:978-283-2726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1136781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical