Healthcare Provider Details

I. General information

NPI: 1972689115
Provider Name (Legal Business Name): PATRICK MOBRAY MCCAGHREN LCSW LICENSED CLINIC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: PATRICK M MCCAGHREN LCSW PA

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 STIRLING RD #6
COOPER CITY FL
33024
US

IV. Provider business mailing address

10000 STIRLING RD #6
COOPER CITY FL
33024
US

V. Phone/Fax

Practice location:
  • Phone: 954-436-8326
  • Fax: 954-433-0603
Mailing address:
  • Phone: 954-436-8326
  • Fax: 954-433-0603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW0002717
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: