Provider Demographics
NPI:1346527371
Name:MCGOVERN, KATHRYN (DAC, LAC, LMT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:DAC, LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 GREAT EAST NECK RD
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-7609
Mailing Address - Country:US
Mailing Address - Phone:631-235-7511
Mailing Address - Fax:
Practice Address - Street 1:421 GREAT EAST NECK RD
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-7609
Practice Address - Country:US
Practice Address - Phone:631-235-7511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-04
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024813225700000X
NY005453171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist