Provider Demographics
NPI:1851782403
Name:MCBRIDE, MEGAN
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5725 FIVE FLAGS BLVD
Mailing Address - Street 2:APT 2029
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-2561
Mailing Address - Country:US
Mailing Address - Phone:321-331-0947
Mailing Address - Fax:
Practice Address - Street 1:5725 FIVE FLAGS BLVD
Practice Address - Street 2:APT 2029
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-2561
Practice Address - Country:US
Practice Address - Phone:321-331-0947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL925918101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool