Provider Demographics
NPI:1699868646
Name:MCCAULEY, MICHAEL R (LCSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:MCCAULEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 S RANDOLPH AVE
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-3739
Mailing Address - Country:US
Mailing Address - Phone:304-637-1002
Mailing Address - Fax:304-636-3829
Practice Address - Street 1:10 S RANDOLPH AVE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3713
Practice Address - Country:US
Practice Address - Phone:304-637-1002
Practice Address - Fax:304-636-3829
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVCP008165011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVMCSW 23601Medicare ID - Type Unspecified