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General NPI Number Information
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NPI Number | 1326012477
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Entity Type | Individual
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Provider Name | LORI P MCKENNA MSW LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/15/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1 KENNEDY DR L6 LORI P MCKENNA
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City | SO BURLINGTON
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State | UT
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Zip | 05461
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Country | US
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Telephone | 802-862-0400
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Fax |
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Provider Business Mailing Address
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Address Line | 177 TRILLIUM LN
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City | HINESBURG
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State | VT
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Zip | 05461-9048
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Country | US
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Telephone | 802-482-3132
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 0890000249
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License Number State | VT
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