Provider Demographics
NPI:1619507142
Name:MCGOWAN, JOHN ANTHONY
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ANTHONY
Last Name:MCGOWAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EXT. ZANO GANDIA A10 #239
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612
Mailing Address - Country:US
Mailing Address - Phone:939-241-4252
Mailing Address - Fax:
Practice Address - Street 1:EXT. ZANO GANDIA A10 #239
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-0061
Practice Address - Country:US
Practice Address - Phone:939-241-4252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR149831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical