Provider Demographics
NPI:1457410219
Name:MCKINNON, SEAN R (MED)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:R
Last Name:MCKINNON
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 GROVE ST
Mailing Address - Street 2:BUILDING #2
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-2263
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:857 TURNPIKE ST
Practice Address - Street 2:SUITE 136
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-6140
Practice Address - Country:US
Practice Address - Phone:603-212-9109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6513101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health