Provider Demographics
NPI:1528047131
Name:MCGOUGH, WILLIAM MICHAEL (LCSW, CASAC)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:MICHAEL
Last Name:MCGOUGH
Suffix:
Gender:M
Credentials:LCSW, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 EPISCOPAL AVE
Mailing Address - Street 2:
Mailing Address - City:HONEOYE FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14472-1001
Mailing Address - Country:US
Mailing Address - Phone:585-624-1350
Mailing Address - Fax:585-624-9181
Practice Address - Street 1:3 EPISCOPAL AVE
Practice Address - Street 2:
Practice Address - City:HONEOYE FALLS
Practice Address - State:NY
Practice Address - Zip Code:14472-1001
Practice Address - Country:US
Practice Address - Phone:585-624-1350
Practice Address - Fax:585-624-9181
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO33420101YM0800X
NY8239101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02308345Medicaid
NY100396FKOtherPREFERRED CARE
NYPO10033420OtherBLUE CROSS/SHIELD
NY5370814OtherAETNA
NY02308345Medicaid
NY100396FKOtherPREFERRED CARE