Provider Demographics
NPI:1770551376
Name:MAGUIRE, MICHELLE (MSW LCSW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MAGUIRE
Suffix:
Gender:F
Credentials:MSW 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 8612
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64508-8612
Mailing Address - Country:US
Mailing Address - Phone:816-232-4417
Mailing Address - Fax:816-901-1053
Practice Address - Street 1:3408 WILSHIRE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4340
Practice Address - Country:US
Practice Address - Phone:910-763-9933
Practice Address - Fax:910-763-9910
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW0055631041C0700X
NCC0071611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO498740109Medicaid
F29F193AMedicare ID - Type UnspecifiedPART B ST. JOSEPH CLINICS
MO498740109Medicaid