Provider Demographics
NPI:1770898694
Name:MCKENNA, JENNIFER CONSTANCE (PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:CONSTANCE
Last Name:MCKENNA
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Gender:F
Credentials:PMHNP-BC
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Mailing Address - Street 1:1 BALTIC PL STE 201A
Mailing Address - Street 2:
Mailing Address - City:CROTON ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:10520-1641
Mailing Address - Country:US
Mailing Address - Phone:914-418-4580
Mailing Address - Fax:914-485-4518
Practice Address - Street 1:1 BALTIC PL STE 201A
Practice Address - Street 2:
Practice Address - City:CROTON ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:10520-1641
Practice Address - Country:US
Practice Address - Phone:914-418-4580
Practice Address - Fax:914-485-4518
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-16
Last Update Date:2019-07-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NYF381954-1363LP0200X
NY401330363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics