Provider Demographics
NPI:1629773890
Name:MCKINNEY, TAINESHA NICOLE (LCSW)
Entity Type:Individual
Prefix:
First Name:TAINESHA
Middle Name:NICOLE
Last Name:MCKINNEY
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 1:17 DENNIS PL
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-1526
Mailing Address - Country:US
Mailing Address - Phone:347-385-3198
Mailing Address - Fax:
Practice Address - Street 1:554 BLOOMFIELD AVE FL 4
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3307
Practice Address - Country:US
Practice Address - Phone:973-771-3300
Practice Address - Fax:973-679-2784
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC060154001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical