Mckenna, Carol A
Mckenna, Carol A is an sole proprietor health care provider with primary practice located at 140 Wood Rd Ste 101, Braintree MA 02184-2512. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Mckenna, Carol A can be contacted via phone (617) 407-4705.Contact Information
Primary practice address
140 Wood Rd Ste 101
Braintree MA 02184-2512
Phone: (617) 407-4705
Fax: (617) 607-7567
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | 7479 | Massachusetts |
Profile Details
| NPI number | 1619153673 |
|---|---|
| LBN Legal business name | Mckenna, Carol A |
| Credentials | PHD |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jan 21st, 2008 |
| Last updated | Apr 12th, 2018 - about 8 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1619153673 | NPPES |
| Massachusetts | Other | 828377534 | OPTUM |
| Massachusetts | Other | 8329-01 | OPTUM |
| Massachusetts | Other | 21482 | OPTUM |
| Massachusetts | Other | V22582 | OPTUM |
| Massachusetts | MEDICAID | 110093018A | OPTUM |
| Massachusetts | Other | W05840 | OPTUM |
| Massachusetts | Other | 138881 | OPTUM |
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