Provider Demographics
NPI:1790996767
Name:MCKENNA, ELIZABETH R (RN, LCSW-R)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:R
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:RN, LCSW-R
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Mailing Address - Street 1:1376 MIDLAND AVE
Mailing Address - Street 2:#205
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-6891
Mailing Address - Country:US
Mailing Address - Phone:914-953-7155
Mailing Address - Fax:866-587-9089
Practice Address - Street 1:4 CHATSWORTH AVE
Practice Address - Street 2:202A
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-2946
Practice Address - Country:US
Practice Address - Phone:914-953-7155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYR0537801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical