Provider Demographics
NPI:1417558610
Name:MCKEE, MARY MARTHA (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MARTHA
Last Name:MCKEE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4785
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70821-4785
Mailing Address - Country:US
Mailing Address - Phone:225-336-8708
Mailing Address - Fax:225-336-8703
Practice Address - Street 1:1900 S ACADIAN THRUWAY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-1665
Practice Address - Country:US
Practice Address - Phone:225-303-8598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0117781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical