Provider Demographics
NPI:1134081516
Name:MCGOUGHY, IRENE BEAUTY
Entity type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:BEAUTY
Last Name:MCGOUGHY
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 1:4601 KING ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-2217
Mailing Address - Country:US
Mailing Address - Phone:757-541-0423
Mailing Address - Fax:
Practice Address - Street 1:4601 KING ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-2217
Practice Address - Country:US
Practice Address - Phone:757-541-0423
Practice Address - Fax:757-991-1608
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-24
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA11911067251S00000X, 385H00000X, 251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No385H00000XRespite Care FacilityRespite Care