Mckenna, Theresa Ann

Mckenna, Theresa Ann is an individual health care provider with primary practice located at 200 Belle Terre Rd , Port Jefferson NY 11777-1928. She recently has only one registered license in Behavioral Health & Social Service Providers / Psychologist, which is considered as her primary health care specialty. Mckenna, Theresa Ann can be contacted via phone (631) 474-6000.

Contact Information

Primary practice address
200 Belle Terre Rd Port Jefferson NY 11777-1928
Phone: (631) 474-6000
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X 013779 New York

Profile Details

NPI number 1568463560
LBN Legal business name Mckenna, Theresa Ann
Credentials PHD
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 2nd, 2005
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1568463560 NPPES
New York MEDICAID 013779

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