Provider Demographics
NPI:1306100193
Name:MCGINNIS, MARY L (MSED)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:L
Last Name:MCGINNIS
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 LINCOLN AVE
Mailing Address - Street 2:APT. RR
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2415
Mailing Address - Country:US
Mailing Address - Phone:718-667-1673
Mailing Address - Fax:
Practice Address - Street 1:91 LINCOLN AVE
Practice Address - Street 2:APT. RR
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2415
Practice Address - Country:US
Practice Address - Phone:718-667-1673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst