Healthcare Provider Details

I. General information

NPI: 1851859607
Provider Name (Legal Business Name): ERIN MCKENNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2019
Last Update Date: 03/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 N BROAD ST STE D101
PHILADELPHIA PA
19140-5103
US

IV. Provider business mailing address

1500 MARKET ST. LM 500 WEST TOWER
PHILADELPHIA PA
19102
US

V. Phone/Fax

Practice location:
  • Phone: 215-731-7144
  • Fax:
Mailing address:
  • Phone: 215-731-2406
  • Fax: 267-765-2325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW018098
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: