Provider Demographics
NPI:1134289861
Name:MCGREEVY, CHARLES PATRICK (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:PATRICK
Last Name:MCGREEVY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7101 PROSPECT PL NE
Mailing Address - Street 2:7107 PROSPECT PL NE
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-4332
Mailing Address - Country:US
Mailing Address - Phone:505-298-2658
Mailing Address - Fax:505-856-2069
Practice Address - Street 1:7113 PROSPECT PL NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4313
Practice Address - Country:US
Practice Address - Phone:505-298-2658
Practice Address - Fax:505-856-2069
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM156103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM 100837Medicaid
NM201006582OtherPSYCHOLOGIST