Provider Demographics
NPI:1376390476
Name:MCKENNA, KERRYANN SOLARIS
Entity type:Individual
Prefix:
First Name:KERRYANN
Middle Name:SOLARIS
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:ANN
Other - Last Name:MCKENNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:94 ARAPAHO TRL
Mailing Address - Street 2:
Mailing Address - City:BRANCHBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-5415
Mailing Address - Country:US
Mailing Address - Phone:908-963-7084
Mailing Address - Fax:
Practice Address - Street 1:5131 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-2585
Practice Address - Country:US
Practice Address - Phone:908-963-7084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist