Provider Demographics
NPI:1477695674
Name:MCKEON, LYNETTE (PSYD)
Entity type:Individual
Prefix:DR
First Name:LYNETTE
Middle Name:
Last Name:MCKEON
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 1:1 SPRINGFIELD AVE STE 2C
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-4055
Mailing Address - Country:US
Mailing Address - Phone:908-393-1533
Mailing Address - Fax:908-393-1534
Practice Address - Street 1:1 SPRINGFIELD AVE STE 2C
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-4055
Practice Address - Country:US
Practice Address - Phone:908-393-1533
Practice Address - Fax:908-393-1534
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4059103T00000X, 103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical