Provider Demographics
NPI:1851125751
Name:MCKINNON, DENNIS MATTHEW (PMHNP)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:MATTHEW
Last Name:MCKINNON
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 BOXFORD RD
Mailing Address - Street 2:
Mailing Address - City:ROWLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01969-2424
Mailing Address - Country:US
Mailing Address - Phone:617-240-7480
Mailing Address - Fax:
Practice Address - Street 1:50 DUNHAM RD STE 32003350
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-1882
Practice Address - Country:US
Practice Address - Phone:978-545-9958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-02
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN272617363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health