Provider Demographics
NPI:1780923649
Name:MCMENEMY, RALPH MICHAEL (LCSW-C)
Entity type:Individual
Prefix:MR
First Name:RALPH
Middle Name:MICHAEL
Last Name:MCMENEMY
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 OLD GAINESVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:INTERLACHEN
Mailing Address - State:FL
Mailing Address - Zip Code:32148-5435
Mailing Address - Country:US
Mailing Address - Phone:410-299-9821
Mailing Address - Fax:757-210-5988
Practice Address - Street 1:1023 OLD GAINESVILLE HIGHWAY
Practice Address - Street 2:
Practice Address - City:INTERLACHEN
Practice Address - State:FL
Practice Address - Zip Code:32148
Practice Address - Country:US
Practice Address - Phone:410-299-9821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-12
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD050701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical