Provider Demographics
NPI:1265719041
Name:MCKINNON, RAYNA RUTH (PSYD)
Entity type:Individual
Prefix:
First Name:RAYNA
Middle Name:RUTH
Last Name:MCKINNON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 STERIGERE ST
Mailing Address - Street 2:NORRISTOWN STATE HOSPITAL
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401-5300
Mailing Address - Country:US
Mailing Address - Phone:610-313-1000
Mailing Address - Fax:610-313-1013
Practice Address - Street 1:1001 STERIGERE ST
Practice Address - Street 2:NORRISTOWN STATE HOSPITAL
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-5300
Practice Address - Country:US
Practice Address - Phone:610-313-1000
Practice Address - Fax:610-313-1013
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017068103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical