Provider Demographics
NPI:1992043756
Name:MCKEON, REBECCA ANN (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:ANN
Last Name:MCKEON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 MATHER ST
Mailing Address - Street 2:UNIT 104
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-3148
Mailing Address - Country:US
Mailing Address - Phone:203-980-7796
Mailing Address - Fax:
Practice Address - Street 1:205 ORANGE ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-2069
Practice Address - Country:US
Practice Address - Phone:203-776-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0076941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical