Provider Demographics
NPI:1730393844
Name:MCGOVERN, MAUREEN EILEEN (MSW PHD)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:EILEEN
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:MSW PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 GREENWICH ST
Mailing Address - Street 2:11 L
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-2708
Mailing Address - Country:US
Mailing Address - Phone:212-929-0451
Mailing Address - Fax:
Practice Address - Street 1:310 GREENWICH STREET
Practice Address - Street 2:11 L
Practice Address - City:NYC
Practice Address - State:NY
Practice Address - Zip Code:10013
Practice Address - Country:US
Practice Address - Phone:212-929-0451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
102L00000X
NYR023124-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst