Provider Demographics
NPI:1104181056
Name:MCGINNIS, COLLEEN (PSYD, LP)
Entity type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:
Last Name:MCGINNIS
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 CARTER DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-5846
Mailing Address - Country:US
Mailing Address - Phone:302-276-6144
Mailing Address - Fax:302-376-6145
Practice Address - Street 1:292 CARTER DR
Practice Address - Street 2:SUITE B
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-5846
Practice Address - Country:US
Practice Address - Phone:302-376-6144
Practice Address - Fax:302-376-6145
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB1-0000951103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical