Provider Demographics
NPI:1659886687
Name:MCGURK, RYAN J (LMHC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:J
Last Name:MCGURK
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2225
Mailing Address - Country:US
Mailing Address - Phone:631-928-0202
Mailing Address - Fax:631-928-4385
Practice Address - Street 1:1401 MAIN ST
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2225
Practice Address - Country:US
Practice Address - Phone:631-928-0202
Practice Address - Fax:631-928-4385
Is Sole Proprietor?:No
Enumeration Date:2017-12-13
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007047101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health