Healthcare Provider Details

I. General information

NPI: 1710104864
Provider Name (Legal Business Name): LYNETTE MCKEON, PSY.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SPRINGFIELD AVE STE 2C
SUMMIT NJ
07901-4055
US

IV. Provider business mailing address

1 SPRINGFIELD AVE STE 2C
SUMMIT NJ
07901-4055
US

V. Phone/Fax

Practice location:
  • Phone: 908-393-1533
  • Fax: 908-393-1534
Mailing address:
  • Phone: 908-393-1533
  • Fax: 908-393-1534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number4059
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4059
License Number StateNJ

VIII. Authorized Official

Name: LYNETTE MCKEON
Title or Position: NEUROPSYCHOLOGIST / BUSINESS OWNER
Credential: PSYD
Phone: 908-393-1533