Mary Alice McKennell, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCS 15254 Issued in CA

Practice address

11201 Benton St
Loma Linda VA Healthcare System
Loma Linda, CA 92357-1000

Phone

(909) 825-7084

Fax

(909) 422-3186

NPI assigned

Aug 31, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mary Alice McKennell Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Darrell Broaddus Psychological Services PC

  • Clinical Psychologist
  • Orangevale, CA
  • NPI 1215339650
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465776000000",
    "number": "1356452288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26259 NOTTINGHAM DR",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923544164",
            "telephone_number": "909-825-7084",
            "fax_number": "909-422-3186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11201 BENTON ST",
            "address_2": "LOMA LINDA VA HEALTHCARE SYSTEM",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923571000",
            "telephone_number": "909-825-7084",
            "fax_number": "909-422-3186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKENNELL",
        "first_name": "MARY",
        "middle_name": "ALICE",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2016-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS 15254",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "MCKENNELL",
            "middle_name": "ALICE",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Wyatt Creighton McGilvery, DO
• Erica McIntosh, LCSW, MSW
• Hannah Jane McIntosh
• Deborah W McIvor, M.D.
• Kevin McKay
• Justin Daniel McLarty, M.D.
• Brian McLean, M.D.
• Lynn K. McLean, M.D.
• Kylie Richelle McMath, FNP-C
• James Ira McMillan, M.D.

• Clinical Social Worker in Loma Linda, CA
• Providers in Loma Linda, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.