Provider Demographics
NPI:1083176093
Name:MCGOWAN, LYNDA (LCSW)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 RICHARD DR
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-1503
Mailing Address - Country:US
Mailing Address - Phone:201-965-7124
Mailing Address - Fax:
Practice Address - Street 1:401 WASHINGTON AVE STE 2-2
Practice Address - Street 2:
Practice Address - City:DUMONT
Practice Address - State:NJ
Practice Address - Zip Code:07628-1510
Practice Address - Country:US
Practice Address - Phone:201-965-7124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-01
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC014837001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ44SC01483700OtherBOARD OF SOCIAL WORK EXAMINERS