Provider Demographics
NPI:1861721441
Name:MCGINNIS, AMELIA JANE (LCSW)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:JANE
Last Name:MCGINNIS
Suffix:
Gender:F
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:PO BOX 465
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:PA
Mailing Address - Zip Code:16851-0465
Mailing Address - Country:US
Mailing Address - Phone:814-862-9969
Mailing Address - Fax:
Practice Address - Street 1:921 PIKE STREET
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:PA
Practice Address - Zip Code:16851-0465
Practice Address - Country:US
Practice Address - Phone:814-862-9969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-10
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0176011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical