Provider Demographics
NPI:1619705548
Name:MCGUINNESS, PAUL
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:MCGUINNESS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 EDGAR AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11719-9655
Mailing Address - Country:US
Mailing Address - Phone:631-286-8282
Mailing Address - Fax:631-438-0882
Practice Address - Street 1:36 EDGAR AVE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11719-9655
Practice Address - Country:US
Practice Address - Phone:631-286-8282
Practice Address - Fax:631-438-0882
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1022091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical