MEDICARE: MS. ANGELA MCKENNEY LCSW, LADC, MHRTC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	CAC3232	ME
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	LC4596	ME
3	1041C0700X	Clinical Social Worker	MC12423	ME
4	1041C0700X	Clinical Social Worker	LC13932	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649269739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANGELA MCKENNEY LCSW, LADC, MHRTC

Provider Business Mailing Address
First Line	:	TOGUS 1 VA CTR
Second Line	:	116-B
City	:	AUGUSTA
State	:	ME
Zip	:	04333-6142
Country	:	US
Telephone Number	:	207-623-8411
Fax Number	:

Provider Business Practice Location Address
First Line	:	TOGUS 1 VA CTR
Second Line	:	116-B
City	:	AUGUSTA
State	:	ME
Zip	:	04333-6142
Country	:	US
Telephone Number	:	207-623-8411
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	03/08/2013

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