Provider Demographics
NPI:1841543147
Name:DEEGAN, GEORGE WILLIAM (PSW874)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:WILLIAM
Last Name:DEEGAN
Suffix:
Gender:M
Credentials:PSW874
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32112-4432
Mailing Address - Country:US
Mailing Address - Phone:386-698-1232
Mailing Address - Fax:386-698-4154
Practice Address - Street 1:306 UNION AVE
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:FL
Practice Address - Zip Code:32112-4432
Practice Address - Country:US
Practice Address - Phone:386-698-1232
Practice Address - Fax:386-698-4154
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5565101YA0400X
NY1905101YA0400X
FLPSW8741041C0700X
NY720724181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)