Provider Demographics
NPI:1104588094
Name:MCGOUGAIN, CHRISTINA
Entity type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:
Last Name:MCGOUGAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 W INMAN AVE
Mailing Address - Street 2:
Mailing Address - City:RAHWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07065-2419
Mailing Address - Country:US
Mailing Address - Phone:929-268-4727
Mailing Address - Fax:
Practice Address - Street 1:424 W INMAN AVE
Practice Address - Street 2:
Practice Address - City:RAHWAY
Practice Address - State:NJ
Practice Address - Zip Code:07065-2419
Practice Address - Country:US
Practice Address - Phone:929-268-4727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency