Healthcare Provider Details

I. General information

NPI: 1235073248
Provider Name (Legal Business Name): LAURA MCKENNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2026
Last Update Date: 04/18/2026
Certification Date: 04/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 FENTON AVE
BRONX NY
10469-5754
US

IV. Provider business mailing address

2320 FENTON AVE
BRONX NY
10469-5754
US

V. Phone/Fax

Practice location:
  • Phone: 914-588-1208
  • Fax:
Mailing address:
  • Phone: 914-588-1208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number072051
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: