Provider Demographics
NPI:1558613257
Name:MCKENNA, LEE ANN
Entity Type:Individual
Prefix:MS
First Name:LEE ANN
Middle Name:
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LEE ANN
Other - Middle Name:
Other - Last Name:MCKENNA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:50 GATEWAY RD.
Mailing Address - Street 2:APT. 133S
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-1280
Mailing Address - Country:US
Mailing Address - Phone:914-423-4808
Mailing Address - Fax:
Practice Address - Street 1:1022 NORTH BROADWAY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10703-1280
Practice Address - Country:US
Practice Address - Phone:914-275-8364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR051247-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical