1063573228 NPI number — MS. MARY ELIZABETH MCGUINN M.S.W.

Table of content: MS. MARY ELIZABETH MCGUINN M.S.W. (NPI 1063573228)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063573228 NPI number — MS. MARY ELIZABETH MCGUINN M.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCGUINN
Provider First Name:
MARY
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.W.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCGUINN
Provider Other First Name:
MARY
Provider Other Middle Name:
BETH
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S.W.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1063573228
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/28/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105A S MAPLE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARK RIDGE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07656-2100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-493-1271
Provider Business Mailing Address Fax Number:
201-782-1909

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300A LAKE ST # B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RAMSEY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07446-1362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-493-1271
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/12/2006

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: 1041C0700X , with the licence number:  44SC04527800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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