Provider Demographics
NPI:1962561001
Name:MCKANE & ASSOCIATES, PC
Entity type:Organization
Organization Name:MCKANE & ASSOCIATES, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKANE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:630-377-7226
Mailing Address - Street 1:1121 E MAIN STR
Mailing Address - Street 2:#210
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174
Mailing Address - Country:US
Mailing Address - Phone:630-377-7226
Mailing Address - Fax:630-377-8826
Practice Address - Street 1:1121 E MAIN ST
Practice Address - Street 2:#210
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2205
Practice Address - Country:US
Practice Address - Phone:630-377-7226
Practice Address - Fax:630-377-8826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0004532166OtherBLUE CROSS BLUE SHIELD
IL0004532166OtherBLUE CROSS BLUE SHIELD