Provider Demographics
NPI:1376874743
Name:MCHUGH, MARY ELLEN (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
Last Name:MCHUGH
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 1:5864 AUVERS BLVD
Mailing Address - Street 2:# 104
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-3777
Mailing Address - Country:US
Mailing Address - Phone:407-963-2388
Mailing Address - Fax:
Practice Address - Street 1:5864 AUVERS BLVD
Practice Address - Street 2:# 104
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-3777
Practice Address - Country:US
Practice Address - Phone:407-963-2388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-24
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW97021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical