Provider Demographics
NPI:1174501084
Name:MCGINNIS, T. MICHAELE (LCSW)
Entity Type:Individual
Prefix:
First Name:T. MICHAELE
Middle Name:
Last Name:MCGINNIS
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 1:1509 BLUE OAK LN
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-7826
Mailing Address - Country:US
Mailing Address - Phone:978-835-5885
Mailing Address - Fax:941-251-7381
Practice Address - Street 1:1509 BLUE OAK LN
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-7826
Practice Address - Country:US
Practice Address - Phone:978-835-5885
Practice Address - Fax:941-251-7381
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA106797104100000X
FL148691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
P05870OtherBLUE CARE ELECT
156112000OtherMAGELLAN BEHAVIORAL
042472266OtherONE HEALTH PLAN
042472266OtherTRICARE CHAMPUS
P05870OtherMEDICARE B
042472266OtherHEALTHCARE VALUE
800010352OtherRAILROAD MEDICARE
P05870OtherBLUE SHIELD HMO BLUE
042472266OtherTHREE RIVERS
2042107OtherFIRST HEALTH
2141318OtherCIGNA HEALTH PLAN
P05870OtherBLUE SHIELD INDEMNITY
042472266OtherPACIFICARE
042472266OtherPRIVATE HEALTHCARE SYSTEM
4141644OtherMVP HEALTH CARE
990061OtherFALLON COMMUNITY HEALTH
990061OtherFALLON COMMUNITY HEALTH