Provider Demographics
NPI:1649341868
Name:MCKENNA, FLORENCE C (LICSW)
Entity type:Individual
Prefix:MS
First Name:FLORENCE
Middle Name:C
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 HOPE ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-1631
Mailing Address - Country:US
Mailing Address - Phone:401-273-5533
Mailing Address - Fax:401-273-3343
Practice Address - Street 1:480 HOPE ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-1631
Practice Address - Country:US
Practice Address - Phone:401-273-5533
Practice Address - Fax:401-273-3343
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW002431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical