Provider Demographics
NPI:1609918630
Name:MCKENNA, WENDY ANDERSON (LCSW)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:ANDERSON
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:LEE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18 JOHN ST
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-2209
Mailing Address - Country:US
Mailing Address - Phone:973-600-0073
Mailing Address - Fax:973-635-7085
Practice Address - Street 1:43 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7508
Practice Address - Country:US
Practice Address - Phone:973-600-0073
Practice Address - Fax:973-635-7085
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053728001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical