Doctor Name: | MRS. COLLEEN ALICE MCKENNA |
NPI Number: | 1194741132 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LISW, LICDC |
License Number: | I-517 |
Business Practice Address: | 35888 Center Ridge Rd Suite 5 North Ridgeville, OH - 440393086 |
Business Phone Number: | 4403271800 |
Business Fax Number: | 4403271533 |
Mailing Address: | 35888 Center Ridge Rd, Suite 5 NORTH RIDGEVILLE |
State: | OH |
Postal Code: | 440393086 |
Phone Number: | 4403271800 |
Fax Number: | 4403271533 |
NPI Enumeration Date: | 07/14/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | I-517 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | OH |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |