Provider Demographics
NPI:1932667573
Name:MCGILLYCUDDY, MEGAN ELIZABETH
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:ELIZABETH
Last Name:MCGILLYCUDDY
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 1:390 UNION BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-6514
Mailing Address - Country:US
Mailing Address - Phone:303-989-8172
Mailing Address - Fax:303-984-4366
Practice Address - Street 1:390 UNION BLVD STE 300
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-6514
Practice Address - Country:US
Practice Address - Phone:303-989-8172
Practice Address - Fax:303-984-4366
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-02
Last Update Date:2019-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician