Healthcare Provider Details

I. General information

NPI: 1871194654
Provider Name (Legal Business Name): MEGAN RATHWEG LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEGAN MCCANN

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1381 S PATRICK DR
PATRICK AFB FL
32925-3606
US

IV. Provider business mailing address

1381 S PATRICK DR
PATRICK AFB FL
32925-3606
US

V. Phone/Fax

Practice location:
  • Phone: 321-494-8241
  • Fax:
Mailing address:
  • Phone: 321-494-8241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW09926868
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: