Provider Demographics
NPI:1699368951
Name:MCKIERNAN, KATHLEEN GRACE (LMSW)
Entity Type:Individual
Prefix:MISS
First Name:KATHLEEN
Middle Name:GRACE
Last Name:MCKIERNAN
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 1:503 SYDNEY RD
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-9539
Mailing Address - Country:US
Mailing Address - Phone:631-880-9340
Mailing Address - Fax:
Practice Address - Street 1:503 SYDNEY RD
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-9539
Practice Address - Country:US
Practice Address - Phone:631-880-9340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-18
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0973061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical