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General NPI Number Information
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NPI Number | 1023763976
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Entity Type | Organization
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Legal Business Name | MCKEON WELLNESS SERVICES LLC
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Dates
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Enumeration Date | 02/18/2022
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Last Update Date | 02/18/2022
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Provider Practice Location Address
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Address Line | 38 MILLER RD
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City | NORTHFORD
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State | CT
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Zip | 06472-1423
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Country | US
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Telephone | 475-234-0308
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Fax |
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Provider Business Mailing Address
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Address Line | 38 MILLER RD
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City | NORTHFORD
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State | CT
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Zip | 06472-1423
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MARIA FORGIONE
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Credential |
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Telephone | 203-848-8305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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