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General NPI Number Information
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NPI Number | 1710104864
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Entity Type | Organization
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Legal Business Name | LYNETTE MCKEON, PSY.D., LLC
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 05/07/2024
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Provider Practice Location Address
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Address Line | 1 SPRINGFIELD AVE STE 2C
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City | SUMMIT
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State | NJ
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Zip | 07901-4055
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Country | US
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Telephone | 908-393-1533
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Fax | 908-393-1534
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Provider Business Mailing Address
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Address Line | 1 SPRINGFIELD AVE STE 2C
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City | SUMMIT
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State | NJ
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Zip | 07901-4055
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Country | US
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Telephone | 908-393-1533
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Fax | 908-393-1534
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Authorized Official
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Title or Position | NEUROPSYCHOLOGIST / BUSINESS OWNER
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Name | LYNETTE MCKEON
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Credential | PSYD
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Telephone | 908-393-1533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 4059
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 4059
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License Number State | NJ
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