Provider Demographics
NPI:1013381177
Name:MCGUCKIN, KELLIE-MARIE (MSW)
Entity Type:Individual
Prefix:
First Name:KELLIE-MARIE
Middle Name:
Last Name:MCGUCKIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 BETHLEHEM PIKE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MONTGOMERYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18936-9710
Mailing Address - Country:US
Mailing Address - Phone:215-308-8141
Mailing Address - Fax:
Practice Address - Street 1:595 BETHLEHEM PIKE
Practice Address - Street 2:SUITE 106
Practice Address - City:MONTGOMERYVILLE
Practice Address - State:PA
Practice Address - Zip Code:18936-9710
Practice Address - Country:US
Practice Address - Phone:215-308-8141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-30
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor