Healthcare Provider Details

I. General information

NPI: 1598143141
Provider Name (Legal Business Name): RORY MCGUILL LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2015
Last Update Date: 05/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 INDIAN SCHOOL RD NE STE A
ALBUQUERQUE NM
87110-4504
US

IV. Provider business mailing address

7301 INDIAN SCHOOL RD NE STE A
ALBUQUERQUE NM
87110-4504
US

V. Phone/Fax

Practice location:
  • Phone: 505-266-0441
  • Fax: 505-266-0504
Mailing address:
  • Phone: 505-266-0441
  • Fax: 505-266-0504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-08446
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: