Provider Demographics
NPI:1689873002
Name:MCKENNA, MARYLUZ POWELL (MSW, LSW)
Entity Type:Individual
Prefix:MS
First Name:MARYLUZ
Middle Name:POWELL
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 LOCKWOOD ST
Mailing Address - Street 2:APT 3
Mailing Address - City:BRADFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01835-7312
Mailing Address - Country:US
Mailing Address - Phone:617-460-5423
Mailing Address - Fax:
Practice Address - Street 1:439 S UNION ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-2837
Practice Address - Country:US
Practice Address - Phone:978-722-2404
Practice Address - Fax:978-681-9508
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA31044031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical