Provider Demographics
NPI:1346239662
Name:MCGOWAN, LINDA RAE (MA MFT)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:RAE
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:MA MFT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1452 COTTONTAIL LN
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-7427
Mailing Address - Country:US
Mailing Address - Phone:858-454-4394
Mailing Address - Fax:858-509-4789
Practice Address - Street 1:505 LOMAS SANTA FE DR
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-1333
Practice Address - Country:US
Practice Address - Phone:858-279-1223
Practice Address - Fax:858-509-4789
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAMFC 38293103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist