Healthcare Provider Details

I. General information

NPI: 1235751744
Provider Name (Legal Business Name): JAMES FRANCIS MCKENNA M.ED, LADC1
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2020
Last Update Date: 05/07/2020
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 E MAIN RD
MIDDLETOWN RI
02842-4988
US

IV. Provider business mailing address

58 E MAIN RD
MIDDLETOWN RI
02842-4988
US

V. Phone/Fax

Practice location:
  • Phone: 401-608-3322
  • Fax: 401-608-3323
Mailing address:
  • Phone: 401-608-3322
  • Fax: 401-608-3323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number919
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: