Healthcare Provider Details

I. General information

NPI: 1922936749
Provider Name (Legal Business Name): BROOKE G MCKENNA PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 BEACON ST STE 324
BROOKLINE MA
02446-3203
US

IV. Provider business mailing address

11 ELLERY ST APT 11
CAMBRIDGE MA
02138-5305
US

V. Phone/Fax

Practice location:
  • Phone: 919-428-1174
  • Fax:
Mailing address:
  • Phone: 919-428-1174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301019679
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: