Provider Demographics
NPI:1982878906
Name:MCKENNA, JOANNE (LICSW)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
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 1:28 GILBERT ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-6806
Mailing Address - Country:US
Mailing Address - Phone:781-710-4172
Mailing Address - Fax:
Practice Address - Street 1:601 HIGH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-1854
Practice Address - Country:US
Practice Address - Phone:781-710-4172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical