Provider Demographics
NPI:1144631714
Name:ESTHER MCDONOUGH DBA CROSSWORKS
Entity type:Organization
Organization Name:ESTHER MCDONOUGH DBA CROSSWORKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPSIT
Authorized Official - Prefix:
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:MCDONOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:239-471-2928
Mailing Address - Street 1:1314 CAPE CORAL PKWY E
Mailing Address - Street 2:322
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-9696
Mailing Address - Country:US
Mailing Address - Phone:239-471-2928
Mailing Address - Fax:239-471-2926
Practice Address - Street 1:1314 CAPE CORAL PKWY E
Practice Address - Street 2:322
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-9696
Practice Address - Country:US
Practice Address - Phone:239-471-2928
Practice Address - Fax:239-471-2926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-16
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 112781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1689854580Medicare NSC
FLHP424AMedicare PIN