Provider Demographics
NPI:1215637095
Name:MAGHANOY, RICK R
Entity type:Individual
Prefix:
First Name:RICK
Middle Name:R
Last Name:MAGHANOY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 819 BOX 4496
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09645-0045
Mailing Address - Country:US
Mailing Address - Phone:360-932-8644
Mailing Address - Fax:
Practice Address - Street 1:NAVAL HOSPITAL ROTA
Practice Address - Street 2:
Practice Address - City:ROTA
Practice Address - State:CADIZ
Practice Address - Zip Code:11520
Practice Address - Country:ES
Practice Address - Phone:360-932-8644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASA61392032104100000X
COLSW.0009924578104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker