Provider Demographics
NPI:1467863597
Name:GORAJ-MCDADE, ANNE MARIE (MA)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:GORAJ-MCDADE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 W 49TH ST STE 105
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6550
Mailing Address - Country:US
Mailing Address - Phone:605-376-8810
Mailing Address - Fax:605-799-8183
Practice Address - Street 1:2200 W 49TH ST STE 105
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-6550
Practice Address - Country:US
Practice Address - Phone:605-376-8810
Practice Address - Fax:605-799-8183
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-12
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00757101YM0800X
SD30565101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD2019736Medicaid