Active NPI
Mary Catherine McKenna, M.A., L.P.
- Psychologist
- Mendota Heights, MN
National Provider Identifier
1053397646
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- LP0831
- Practice address
- 1316 Knollwood LN
Mendota Heights, MN 55118-1739 - Phone
- (651) 552-6762
- NPI assigned
- Dec 16, 2005
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | LP0831 | MN | Primary |
Addresses
Primary practice location
1316 Knollwood LN
Mendota Heights, MN 55118-1739
Mailing address
1316 Knollwood LN
Mendota Heights, MN 55118-1739
Phone (651) 552-6762
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 336K4MC | Other | MN | BLUE CROSS BLUE SHIELD |
| 336K5MC | Other | MN | BCBS INDIVDUAL # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP0831 | MN | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1134691200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1053397646",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1316 KNOLLWOOD LN",
"city": "MENDOTA HEIGHTS",
"state": "MN",
"postal_code": "551181739",
"telephone_number": "651-552-6762"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1316 KNOLLWOOD LN",
"city": "MENDOTA HEIGHTS",
"state": "MN",
"postal_code": "551181739",
"telephone_number": "651-552-6762"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCKENNA",
"first_name": "MARY",
"middle_name": "CATHERINE",
"credential": "M.A., L.P.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-12-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MN",
"license": "LP0831",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "336K4MC",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS INDIVDUAL #",
"identifier": "336K5MC",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mendota Heights, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.