Provider Demographics
NPI:1932494119
Name:MCKENNA, AMANDA J (MS, ED)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:J
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:MS, ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-1817
Mailing Address - Country:US
Mailing Address - Phone:631-974-7854
Mailing Address - Fax:
Practice Address - Street 1:8 8TH AVE
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-1817
Practice Address - Country:US
Practice Address - Phone:631-974-7854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program