Physician Compare National (NPI:1871963306)

HEALTHCARE PROVIDER: ANGELA MACKINNON LCSW, MSW

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1871963306
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3173812054
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20160516002291
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MACKINNON
	Individual professional last name
Provider First Name	ANGELA
	Individual professional first name
Provider Middle Name	L
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2013
	Individual professional's medical school graduation year
Primary Specialty	CLINICAL SOCIAL WORKER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	TRAVIS CORPORATION
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	1850355223
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	3
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	439 S UNION ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 207A PEOPLE CARE CLINIC
	Group Practice or individual's line 2 address
City	LAWRENCE
	Group Practice or individual's city
State	MA
	Group Practice or individual's state
Zip Code	018432837
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9786819652
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y