Provider Demographics
NPI:1215237227
Name:MCKEIRNAN, REBECCA (MSW, LSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:MCKEIRNAN
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 WASHINGTON BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-5355
Mailing Address - Country:US
Mailing Address - Phone:570-321-6390
Mailing Address - Fax:
Practice Address - Street 1:705 WASHINGTON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-5355
Practice Address - Country:US
Practice Address - Phone:570-321-6390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
PASW128834104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100777700036Medicaid