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NPI Code Detail

MEDICARE: MARYANN MC GHEE REARDON LCSW

MEDICARE: MARYANN MC GHEE REARDON LCSW
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
1101YM0800XMental Health CounselorLCS16382CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578644795
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARYANN MC GHEE REARDON LCSW
Provider Business Mailing Address
First Line : 2178 JOHNSON AVE
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93401-4535
Country : US
Telephone Number : 805-461-6060
Fax Number : 805-461-6061
Provider Business Practice Location Address
First Line : 2178 JOHNSON AVE
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93401-4535
Country : US
Telephone Number : 805-461-6060
Fax Number : 805-461-6061
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2006
Last Update Date : 11/19/2013

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