MEDICARE: MS. MARY ELIZABETH MCGUINN M.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	44SC04527800	NJ

General Provider Information

NPI Number	:	1063573228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY ELIZABETH MCGUINN M.S.W.

Provider Business Mailing Address
First Line	:	105A S MAPLE AVE
Second Line	:
City	:	PARK RIDGE
State	:	NJ
Zip	:	07656-2100
Country	:	US
Telephone Number	:	201-493-1271
Fax Number	:	201-782-1909

Provider Business Practice Location Address
First Line	:	300A LAKE ST # B
Second Line	:
City	:	RAMSEY
State	:	NJ
Zip	:	07446-1362
Country	:	US
Telephone Number	:	201-493-1271
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	09/28/2018

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