MEDICARE: MR. WILLIAM MICHAEL MCGOUGH LCSW, CASAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	RO33420	NY
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	8239	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	100396FK	OTHER	NY	PREFERRED CARE
3	PO10033420	OTHER	NY	BLUE CROSS/SHIELD
4	5370814	OTHER	NY	AETNA

General Provider Information

NPI Number	:	1528047131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM MICHAEL MCGOUGH LCSW, CASAC

Provider Business Mailing Address
First Line	:	3 EPISCOPAL AVE
Second Line	:
City	:	HONEOYE FALLS
State	:	NY
Zip	:	14472-1001
Country	:	US
Telephone Number	:	585-624-1350
Fax Number	:	585-624-9181

Provider Business Practice Location Address
First Line	:	3 EPISCOPAL AVE
Second Line	:
City	:	HONEOYE FALLS
State	:	NY
Zip	:	14472-1001
Country	:	US
Telephone Number	:	585-624-1350
Fax Number	:	585-624-9181

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	10/05/2010

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Directions to “ MR. WILLIAM MICHAEL MCGOUGH LCSW, CASAC” Practice Location

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