Provider Demographics
NPI:1255178737
Name:MCKECHNIE, COLLEEN ERIN (PSYD)
Entity type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:ERIN
Last Name:MCKECHNIE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 STANTON ST
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-1651
Mailing Address - Country:US
Mailing Address - Phone:631-219-9047
Mailing Address - Fax:
Practice Address - Street 1:299 MAIN ST STE 7
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-1755
Practice Address - Country:US
Practice Address - Phone:631-219-9047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026429-01103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical