Provider Demographics
NPI:1992211692
Name:MCGORTY, MICHAEL (LPC, LCADC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MCGORTY
Suffix:
Gender:M
Credentials:LPC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MILL RIDGE LN STE 204
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07930-2489
Mailing Address - Country:US
Mailing Address - Phone:908-914-2624
Mailing Address - Fax:
Practice Address - Street 1:1 MILL RIDGE LN STE 204
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NJ
Practice Address - Zip Code:07930-2489
Practice Address - Country:US
Practice Address - Phone:908-914-2624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-18
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00273100101YA0400X
NJ37PC00583300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty