Provider Demographics
NPI:1225021744
Name:MCGOWN, DOROTHY BENSON (LCSW)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:BENSON
Last Name:MCGOWN
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 1:4161 CARMICHAEL AVE
Mailing Address - Street 2:BLDG 3300, SUITE 150
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-2353
Mailing Address - Country:US
Mailing Address - Phone:904-396-8750
Mailing Address - Fax:904-396-8759
Practice Address - Street 1:1601 S.W. ARCHER ROAD
Practice Address - Street 2:MALCOM RANDALL VA MEDICAL CENTER
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-1197
Practice Address - Country:US
Practice Address - Phone:352-376-1611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW44621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ7570Medicare ID - Type Unspecified