Healthcare Provider Details

I. General information

NPI: 1669862991
Provider Name (Legal Business Name): JENNA MCKEAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2015
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1241
NEW CITY NY
10956-8241
US

IV. Provider business mailing address

PO BOX 1241
NEW CITY NY
10956-8241
US

V. Phone/Fax

Practice location:
  • Phone: 845-893-5384
  • Fax:
Mailing address:
  • Phone: 845-893-5384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number005203
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: