Provider Demographics
NPI:1861881310
Name:SUZANNE S MCKANN PHD
Entity type:Organization
Organization Name:SUZANNE S MCKANN PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCKANN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCPC
Authorized Official - Phone:301-479-4502
Mailing Address - Street 1:7208 JAMES I HARRIS MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-3630
Mailing Address - Country:US
Mailing Address - Phone:301-473-4502
Mailing Address - Fax:
Practice Address - Street 1:7208 JAMES I HARRIS MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-3630
Practice Address - Country:US
Practice Address - Phone:301-473-4502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health