Provider Demographics
NPI:1619111481
Name:MCKENNA, MARY DESMOND (MSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:DESMOND
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 PARK RD NW APT 4
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-1041
Mailing Address - Country:US
Mailing Address - Phone:202-332-2604
Mailing Address - Fax:
Practice Address - Street 1:1801 PARK RD NW APT 4
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-1041
Practice Address - Country:US
Practice Address - Phone:202-332-2604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG50078903104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker