Provider Demographics
NPI:1063573228
Name:MCGUINN, MARY ELIZABETH (MSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELIZABETH
Last Name:MCGUINN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:BETH
Other - Last Name:MCGUINN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:105A S MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07656-2100
Mailing Address - Country:US
Mailing Address - Phone:201-493-1271
Mailing Address - Fax:201-782-1909
Practice Address - Street 1:300A LAKE ST # B
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-1362
Practice Address - Country:US
Practice Address - Phone:201-493-1271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC045278001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ050284Medicare ID - Type Unspecified