Provider Demographics
NPI:1679880439
Name:MCCLUSKEY, MEGHANN J (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MEGHANN
Middle Name:J
Last Name:MCCLUSKEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 BISHOP STREET
Mailing Address - Street 2:UNIT 3 ROOM 8
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-1931
Mailing Address - Country:US
Mailing Address - Phone:207-370-1331
Mailing Address - Fax:
Practice Address - Street 1:68 BISHOP ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2681
Practice Address - Country:US
Practice Address - Phone:079-392-2842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081903-1104100000X
MELC152941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEE400210323Medicare PIN