=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568955631
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEGHAN ELIZABETH MCCUE MS, LAC, NBCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2018
-----------------------------------------------------
Last Update Date | 06/12/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 727 N BEERS ST
-----------------------------------------------------
City | HOLMDEL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07733-1514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-433-9807
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 104 CHURCH ST
-----------------------------------------------------
City | FAIR HAVEN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07704-3418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 37AC00371400
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------