Provider Demographics
NPI:1215311576
Name:MCKENNA, JAMIE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:SHARP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 PLEASANT HILL ROAD
Mailing Address - Street 2:UNIT 160
Mailing Address - City:SEBASTOPAL
Mailing Address - State:CA
Mailing Address - Zip Code:95472
Mailing Address - Country:US
Mailing Address - Phone:510-655-7880
Mailing Address - Fax:
Practice Address - Street 1:120 PLEASANT HILL ROAD
Practice Address - Street 2:UNIT 160
Practice Address - City:SEBASTOPAL
Practice Address - State:CA
Practice Address - Zip Code:95472
Practice Address - Country:US
Practice Address - Phone:707-582-0404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program