1720524879 NPI number — MRS. GINA CATHERINE MCCUE LCSW

Table of content: MRS. GINA CATHERINE MCCUE LCSW (NPI 1720524879)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720524879 NPI number — MRS. GINA CATHERINE MCCUE LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCUE
Provider First Name:
GINA
Provider Middle Name:
CATHERINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HARRISON
Provider Other First Name:
GINA
Provider Other Middle Name:
CATHERINE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720524879
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5001 N PIEDRAS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79930-4210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-564-6100
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5001 N PIEDRAS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79930-4210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-504-5446
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/12/2017

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:  53630 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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