Provider Demographics
NPI:1144484452
Name:MCKENNA, JULIE A (PHD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:A
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 KENILWORTH DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2313
Mailing Address - Country:US
Mailing Address - Phone:443-386-0535
Mailing Address - Fax:
Practice Address - Street 1:660 KENILWORTH DR
Practice Address - Street 2:SUITE 101
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2313
Practice Address - Country:US
Practice Address - Phone:443-386-0535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04398103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical