Provider Demographics
NPI:1538468418
Name:MCKINNEY, PATRICIA R
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:R
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:R
Other - Last Name:TERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:216 HIGH ST
Mailing Address - Street 2:PMB 314
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-1742
Mailing Address - Country:US
Mailing Address - Phone:207-812-5350
Mailing Address - Fax:
Practice Address - Street 1:216 HIGH ST
Practice Address - Street 2:PMB 314
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1742
Practice Address - Country:US
Practice Address - Phone:207-812-5350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor