Healthcare Provider Details

I. General information

NPI: 1689764987
Provider Name (Legal Business Name): LUCILLE ANN MCGOURTY LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1261 FURNACE BROOK PKWY STE 31
QUINCY MA
02169-4762
US

IV. Provider business mailing address

74 HOBART ST
BRAINTREE MA
02184-3441
US

V. Phone/Fax

Practice location:
  • Phone: 617-479-4545
  • Fax: 617-479-4555
Mailing address:
  • Phone: 781-848-2363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: