Provider Demographics
NPI:1699857292
Name:MCGOVERN, NANCY D (PHD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:D
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21632 WESLEY DR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-8167
Mailing Address - Country:US
Mailing Address - Phone:949-499-5346
Mailing Address - Fax:949-499-1594
Practice Address - Street 1:21632 WESLEY DR
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-8167
Practice Address - Country:US
Practice Address - Phone:949-499-5346
Practice Address - Fax:949-499-1594
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13242103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical