Provider Demographics
NPI:1063572691
Name:MCNAMARA, MAUREEN (LMSW DCSW)
Entity type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:
Last Name:MCNAMARA
Suffix:
Gender:F
Credentials:LMSW DCSW
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:
Other - Last Name:KILKELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1520 TEXEL DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1327
Mailing Address - Country:US
Mailing Address - Phone:269-660-3905
Mailing Address - Fax:269-660-3899
Practice Address - Street 1:36 W MANCHESTER ST
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3016
Practice Address - Country:US
Practice Address - Phone:269-660-3905
Practice Address - Fax:269-660-3899
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010343861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
172774OtherMHN
5821754OtherAETNA
6274622OtherPHP IBA
IP294508OtherTRICARE
0890246OtherBCBS
MI126312OtherVALUE OPTIONS
5821754OtherMAGELLAN
6274622OtherUBH
VA27087OtherVALUE OPTIONS
5821754OtherAETNA
OM99440Medicare UPIN