Healthcare Provider Details

I. General information

NPI: 1578491734
Provider Name (Legal Business Name): MARY CLAIRE MCKENNA LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 CITY LINE RD STE 300
BETHLEHEM PA
18017-7701
US

IV. Provider business mailing address

626 N 2ND ST
EMMAUS PA
18049-2515
US

V. Phone/Fax

Practice location:
  • Phone: 610-865-8177
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW143202
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: