Provider Demographics
NPI:1336833193
Name:MCGONIGAL, ANN (MSS, LCSW, CMC)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:MCGONIGAL
Suffix:
Gender:F
Credentials:MSS, LCSW, CMC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3215 CRYSTAL CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-2256
Mailing Address - Country:US
Mailing Address - Phone:610-324-2916
Mailing Address - Fax:
Practice Address - Street 1:3215 CRYSTAL CT
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-2256
Practice Address - Country:US
Practice Address - Phone:610-324-2916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00007261041C0700X
PACW0140861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical