MEDICARE: KATHLEEN MCKENNA MS, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	37PC00383400	NJ

General Provider Information

NPI Number	:	1639498546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN MCKENNA MS, LPC

Provider Business Mailing Address
First Line	:	5046 CLAYTON AVE
Second Line	:
City	:	PENNSAUKEN
State	:	NJ
Zip	:	08109-1910
Country	:	US
Telephone Number	:	856-356-3928
Fax Number	:

Provider Business Practice Location Address
First Line	:	5046 CLAYTON AVE
Second Line	:
City	:	PENNSAUKEN
State	:	NJ
Zip	:	08109-1910
Country	:	US
Telephone Number	:	856-356-3928
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2010
Last Update Date	:	05/18/2010

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