Provider Demographics
NPI:1669266573
Name:MCKINNISS, JODI ERIN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JODI
Middle Name:ERIN
Last Name:MCKINNISS
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 N D ST
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33460-2831
Mailing Address - Country:US
Mailing Address - Phone:561-665-0966
Mailing Address - Fax:
Practice Address - Street 1:409 N D ST
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-2831
Practice Address - Country:US
Practice Address - Phone:561-665-0966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW245491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical