Provider Demographics
NPI:1578057972
Name:MCGINNISS, DEIRDRE NICOLE (LCSW)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:NICOLE
Last Name:MCGINNISS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DEIRDRE
Other - Middle Name:NICOLE
Other - Last Name:BRAZENALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1236 MAIN ST STE 301
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-5370
Mailing Address - Country:US
Mailing Address - Phone:413-561-0060
Mailing Address - Fax:413-532-0253
Practice Address - Street 1:1236 MAIN ST STE 301
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-5370
Practice Address - Country:US
Practice Address - Phone:413-561-0060
Practice Address - Fax:413-532-0253
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA225651104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker