Healthcare Provider Details

I. General information

NPI: 1619705548
Provider Name (Legal Business Name): PAUL MCGUINNESS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 EDGAR AVE
BROOKHAVEN NY
11719-9655
US

IV. Provider business mailing address

36 EDGAR AVE
BROOKHAVEN NY
11719-9655
US

V. Phone/Fax

Practice location:
  • Phone: 631-286-8282
  • Fax: 631-438-0882
Mailing address:
  • Phone: 631-286-8282
  • Fax: 631-438-0882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number102209
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: