Provider Demographics
NPI:1326012477
Name:MCKENNA, LORI P (MSW LCSW)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:P
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 TRILLIUM LN
Mailing Address - Street 2:
Mailing Address - City:HINESBURG
Mailing Address - State:VT
Mailing Address - Zip Code:05461-9048
Mailing Address - Country:US
Mailing Address - Phone:802-482-3132
Mailing Address - Fax:
Practice Address - Street 1:1 KENNEDY DR L6
Practice Address - Street 2:LORI P MCKENNA
Practice Address - City:SO BURLINGTON
Practice Address - State:UT
Practice Address - Zip Code:05461
Practice Address - Country:US
Practice Address - Phone:802-862-0400
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT08900002491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1007207Medicaid
29438OtherBCBS VT