Individual
PETER RICHARD MCKENNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADC-1
Contact information
Practice address
21 CULLEY ST, FITCHBURG, MA 01420-3509
(978) 790-8236
Mailing address
21 CULLEY ST, FITCHBURG, MA 01420-3509
(978) 790-8236
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1379
MA
Other
Enumeration date
10/21/2014
Last updated
12/01/2015
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