1265719041 NPI number — RAYNA RUTH MCKINNON PSY.D.

Table of content: RAYNA RUTH MCKINNON PSY.D. (NPI 1265719041)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265719041 NPI number — RAYNA RUTH MCKINNON PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCKINNON
Provider First Name:
RAYNA
Provider Middle Name:
RUTH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265719041
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 STERIGERE ST
Provider Second Line Business Mailing Address:
NORRISTOWN STATE HOSPITAL
Provider Business Mailing Address City Name:
NORRISTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19401-5300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-313-1000
Provider Business Mailing Address Fax Number:
610-313-1013

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 STERIGERE ST
Provider Second Line Business Practice Location Address:
NORRISTOWN STATE HOSPITAL
Provider Business Practice Location Address City Name:
NORRISTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19401-5300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-313-1000
Provider Business Practice Location Address Fax Number:
610-313-1013
Provider Enumeration Date:
11/08/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PS017068 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)