Provider Information for 1154836112
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Mr. MATTHEW FRANCIS MCKENNA MFT
Sex: Male
NPI: 1154836112
Last Updated: 2017-12-12
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1154836112 | ||||||||||||
| Enumeration Date | 2017-12-12 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 5130 E MAIN STREET RD STE 2 BATAVIA, NY 14020-3444 United States Phone: 585-344-1421 | Fax: | ||||||||||||
| Primary Practice Address | 5130 E MAIN STREET RD STE 2 BATAVIA, NY 14020-3444 United States Phone: 585-344-1421 | Fax: | ||||||||||||
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