Provider Demographics
NPI:1710104864
Name:LYNETTE MCKEON, PSY.D., LLC
Entity type:Organization
Organization Name:LYNETTE MCKEON, PSY.D., LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NEUROPSYCHOLOGIST / BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKEON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:908-393-1533
Mailing Address - Street 1:1 SPRINGFIELD AVE STE 2C
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-4055
Mailing Address - Country:US
Mailing Address - Phone:908-393-1533
Mailing Address - Fax:908-393-1534
Practice Address - Street 1:1 SPRINGFIELD AVE STE 2C
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-4055
Practice Address - Country:US
Practice Address - Phone:908-393-1533
Practice Address - Fax:908-393-1534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4059103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty