Provider Demographics
NPI:1659818813
Name:MCKINNEY, JANE (LCSW)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
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:PO BOX 527
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04576-0527
Mailing Address - Country:US
Mailing Address - Phone:207-380-9593
Mailing Address - Fax:
Practice Address - Street 1:39 RIVER RD
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:ME
Practice Address - Zip Code:04553-3802
Practice Address - Country:US
Practice Address - Phone:207-380-4716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-26
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC1800061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical