Provider Demographics
NPI:1659071900
Name:MCKENY, STASEE J (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:STASEE
Middle Name:J
Last Name:MCKENY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 E SHEA BLVD STE 188
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3354
Mailing Address - Country:US
Mailing Address - Phone:602-633-5474
Mailing Address - Fax:
Practice Address - Street 1:3420 E SHEA BLVD STE 188
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3354
Practice Address - Country:US
Practice Address - Phone:602-633-5474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-20998104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker