Healthcare Provider Details

I. General information

NPI: 1528047131
Provider Name (Legal Business Name): WILLIAM MICHAEL MCGOUGH LCSW, CASAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 10/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 EPISCOPAL AVE
HONEOYE FALLS NY
14472-1001
US

IV. Provider business mailing address

3 EPISCOPAL AVE
HONEOYE FALLS NY
14472-1001
US

V. Phone/Fax

Practice location:
  • Phone: 585-624-1350
  • Fax: 585-624-9181
Mailing address:
  • Phone: 585-624-1350
  • Fax: 585-624-9181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number8239
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberRO33420
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: