Provider Demographics
NPI:1144534033
Name:MCGIVNEY, NATHANNA MALINA (LCSW)
Entity type:Individual
Prefix:
First Name:NATHANNA
Middle Name:MALINA
Last Name:MCGIVNEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NATHANNA
Other - Middle Name:MALINA
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:50 LYDIA LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2156
Mailing Address - Country:US
Mailing Address - Phone:207-766-6757
Mailing Address - Fax:207-874-1181
Practice Address - Street 1:50 LYDIA LN
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2156
Practice Address - Country:US
Practice Address - Phone:207-766-6757
Practice Address - Fax:207-874-1181
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC123061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432358599Medicaid