Provider Demographics
NPI:1598230567
Name:MCKINNEY, JASON (LCSW-R, PHD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:MCKINNEY
Suffix:
Gender:M
Credentials:LCSW-R, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-2543
Mailing Address - Country:US
Mailing Address - Phone:585-944-6116
Mailing Address - Fax:
Practice Address - Street 1:44 HILLTOP DR
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-2543
Practice Address - Country:US
Practice Address - Phone:585-944-6116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0826811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical