Provider Demographics
NPI:1952417966
Name:MCGOWAN SCHWARTZ, MAUREEN (APRN)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:MCGOWAN SCHWARTZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:CT
Mailing Address - Zip Code:06460
Mailing Address - Country:US
Mailing Address - Phone:203-924-5529
Mailing Address - Fax:203-924-5529
Practice Address - Street 1:500 HOWE AVENUE
Practice Address - Street 2:SUITE 202
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484
Practice Address - Country:US
Practice Address - Phone:203-924-5529
Practice Address - Fax:203-924-5529
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002583101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTQ77862Medicare UPIN