Healthcare Provider Details

I. General information

NPI: 1376585794
Provider Name (Legal Business Name): MARIANNE L. D. MCGUIGAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY L. MCGUIGAN PH.D.

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SW ARCHER RD
GAINESVILLE FL
32608-1135
US

IV. Provider business mailing address

1601 SW ARCHER RD
GAINESVILLE FL
32608-1135
US

V. Phone/Fax

Practice location:
  • Phone: 352-374-6020
  • Fax:
Mailing address:
  • Phone: 352-374-6020
  • Fax: 352-379-4026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY0003691
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: