MEDICARE: MR. MATTHEW MCGAHRAN LCSW

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	1041C0700X	Clinical Social Worker	CW014547	PA
2	1041C0700X	Clinical Social Worker	100282	CA

General Provider Information

NPI Number	:	1982670584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATTHEW MCGAHRAN LCSW

Provider Business Mailing Address
First Line	:	1109 DASKALOS DR NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87123-1938
Country	:	US
Telephone Number	:	813-323-1574
Fax Number	:

Provider Business Practice Location Address
First Line	:	3705 W PICO BLVD # 859
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-3451
Country	:	US
Telephone Number	:	858-504-7868
Fax Number	:

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

Provider Enumeration Date	:	02/24/2006
Last Update Date	:	04/25/2024

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