Provider Demographics
NPI:1023763976
Name:MCKEON WELLNESS SERVICES LLC
Entity type:Organization
Organization Name:MCKEON WELLNESS SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FORGIONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-848-8305
Mailing Address - Street 1:38 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06472-1423
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:38 MILLER RD
Practice Address - Street 2:
Practice Address - City:NORTHFORD
Practice Address - State:CT
Practice Address - Zip Code:06472-1423
Practice Address - Country:US
Practice Address - Phone:475-234-0308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty