Provider Demographics
NPI:1396927174
Name:MC KINNON, KEECHA NICOLE (MSW)
Entity type:Individual
Prefix:MISS
First Name:KEECHA
Middle Name:NICOLE
Last Name:MC KINNON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17290 HIGHLAND AVE
Mailing Address - Street 2:APT 3K
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-2869
Mailing Address - Country:US
Mailing Address - Phone:347-400-1871
Mailing Address - Fax:
Practice Address - Street 1:17290 HIGHLAND AVE
Practice Address - Street 2:APT 3K
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-2869
Practice Address - Country:US
Practice Address - Phone:347-400-1871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker