Provider Demographics
NPI:1760982847
Name:MCKINNON, ANNA S (LMSW)
Entity Type:Individual
Prefix:MISS
First Name:ANNA
Middle Name:S
Last Name:MCKINNON
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 1:40 AVENUE B APT 4E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-7583
Mailing Address - Country:US
Mailing Address - Phone:240-676-3554
Mailing Address - Fax:
Practice Address - Street 1:90 PARK AVE FL 17
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1373
Practice Address - Country:US
Practice Address - Phone:646-665-7131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY100446-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health