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NPI Code Detail

MEDICARE: MR. GEORGE WILLIAM DEEGAN PSW874

MEDICARE: MR. GEORGE WILLIAM DEEGAN PSW874
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
1101YA0400XAddiction (Substance Use Disorder) Counselor5565FL
2101YA0400XAddiction (Substance Use Disorder) Counselor1905NY
31041C0700XClinical Social WorkerPSW874FL
41041C0700XClinical Social Worker72072418NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1841543147
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GEORGE WILLIAM DEEGAN PSW874
Provider Business Mailing Address
First Line : 306 UNION AVE
Second Line :
City : CRESCENT CITY
State : FL
Zip : 32112-4432
Country : US
Telephone Number : 386-698-1232
Fax Number : 386-698-4154
Provider Business Practice Location Address
First Line : 306 UNION AVE
Second Line :
City : CRESCENT CITY
State : FL
Zip : 32112-4432
Country : US
Telephone Number : 386-698-1232
Fax Number : 386-698-4154
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2012
Last Update Date : 10/24/2012

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