Provider Demographics
NPI:1306397062
Name:MCDONOUGH, MAUREEN C (MSW)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:C
Last Name:MCDONOUGH
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 1:1542 TULANE AVE
Mailing Address - Street 2:DEPARTMENT OF PSYCHIATRY
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2865
Mailing Address - Country:US
Mailing Address - Phone:504-568-6004
Mailing Address - Fax:
Practice Address - Street 1:1542 TULANE AVE
Practice Address - Street 2:DEPARTMENT OF PSYCHIATRY
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2865
Practice Address - Country:US
Practice Address - Phone:504-568-6004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA116031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical