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General NPI Number Information
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NPI Number | 1114811213
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Entity Type | Organization
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Legal Business Name | DYLAN MCKENNEY MD PLLC
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Dates
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Enumeration Date | 06/04/2025
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 225 COMMERCIAL ST STE 300
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City | PORTLAND
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State | ME
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Zip | 04101-6606
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Country | US
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Telephone | 207-401-4381
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Fax | 207-489-2793
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Provider Business Mailing Address
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Address Line | 225 COMMERCIAL ST STE 300
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City | PORTLAND
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State | ME
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Zip | 04101-6606
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Country | US
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Telephone | 207-401-4381
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Fax | 207-489-2793
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Authorized Official
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Title or Position | OWNER
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Name | DR. DYLAN MCKENNEY
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Credential | MD
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Telephone | 207-577-6123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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