Provider Demographics
NPI:1457409054
Name:MCGILL, MARCIA (MSW)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:MCGILL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 LANDMARK DR
Mailing Address - Street 2:SIUTE 240
Mailing Address - City:BELLEVUE
Mailing Address - State:KY
Mailing Address - Zip Code:41073-1393
Mailing Address - Country:US
Mailing Address - Phone:859-292-3900
Mailing Address - Fax:859-292-3903
Practice Address - Street 1:103 LANDMARK DR
Practice Address - Street 2:SIUTE 240
Practice Address - City:BELLEVUE
Practice Address - State:KY
Practice Address - Zip Code:41073-1393
Practice Address - Country:US
Practice Address - Phone:859-292-3900
Practice Address - Fax:859-292-3903
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-9761041C0700X
OH00054831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0549606Medicare ID - Type Unspecified
KYS11514Medicare UPIN