Healthcare Provider Details

I. General information

NPI: 1184940140
Provider Name (Legal Business Name): PAUL THOMAS MCDONOUGH MSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2010
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 S COAST HWY STE 4104
LAGUNA BEACH CA
92651-3681
US

IV. Provider business mailing address

1968 S COAST HWY STE 4104
LAGUNA BEACH CA
92651-3681
US

V. Phone/Fax

Practice location:
  • Phone: 714-696-9492
  • Fax:
Mailing address:
  • Phone: 714-696-9492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number27277
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: