Provider Demographics
NPI:1396079125
Name:MCKENNA, ELIZA CHRISTINE (LCSW)
Entity type:Individual
Prefix:MS
First Name:ELIZA
Middle Name:CHRISTINE
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 ROSEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-4326
Mailing Address - Country:US
Mailing Address - Phone:510-495-5440
Mailing Address - Fax:415-775-7730
Practice Address - Street 1:2202 ROSEDALE AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-4326
Practice Address - Country:US
Practice Address - Phone:510-495-5440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-26
Last Update Date:2022-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA258511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical