Provider Demographics
NPI:1972796449
Name:MCGINNIS, RAYMOND PATRICK (LCSW)
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:PATRICK
Last Name:MCGINNIS
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 1:1016 DAWNE DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-9767
Mailing Address - Country:US
Mailing Address - Phone:570-419-4084
Mailing Address - Fax:
Practice Address - Street 1:1016 DAWNE DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-9767
Practice Address - Country:US
Practice Address - Phone:570-419-4084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-19
Last Update Date:2007-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0139261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical