Provider Demographics
NPI:1588724686
Name:MCCUE, SALLY LYNN (LICSW)
Entity type:Individual
Prefix:MS
First Name:SALLY
Middle Name:LYNN
Last Name:MCCUE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BRYN MAWR WAY
Mailing Address - Street 2:
Mailing Address - City:NEWBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01951-2005
Mailing Address - Country:US
Mailing Address - Phone:978-835-7717
Mailing Address - Fax:
Practice Address - Street 1:51 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-2625
Practice Address - Country:US
Practice Address - Phone:978-835-7717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1112871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical