Healthcare Provider Details

I. General information

NPI: 1326012477
Provider Name (Legal Business Name): LORI P MCKENNA MSW LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KENNEDY DR L6 LORI P MCKENNA
SO BURLINGTON UT
05461
US

IV. Provider business mailing address

177 TRILLIUM LN
HINESBURG VT
05461-9048
US

V. Phone/Fax

Practice location:
  • Phone: 802-862-0400
  • Fax:
Mailing address:
  • Phone: 802-482-3132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0890000249
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: