1689764987 NPI number — MRS. LUCILLE ANN MCGOURTY LMHC

Table of content: MRS. LUCILLE ANN MCGOURTY LMHC (NPI 1689764987)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689764987 NPI number — MRS. LUCILLE ANN MCGOURTY LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCGOURTY
Provider First Name:
LUCILLE
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMHC
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:
1689764987
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
74 HOBART ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRAINTREE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02184-3441
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-848-2363
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1261 FURNACE BROOK PKWY STE 31
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
QUINCY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02169-4762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-479-4545
Provider Business Practice Location Address Fax Number:
617-479-4555
Provider Enumeration Date:
10/15/2006

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com