Provider Demographics
NPI:1396045175
Name:MCNEAL, MAUREEN R (LICSW,LMFT)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:R
Last Name:MCNEAL
Suffix:
Gender:F
Credentials:LICSW,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18300 MINNETONKA BLVD
Mailing Address - Street 2:112
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-3272
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18300 MINNETONKA BLVD
Practice Address - Street 2:112
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-3272
Practice Address - Country:US
Practice Address - Phone:952-250-8639
Practice Address - Fax:952-933-1046
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN75021041C0700X
MN57106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist