Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 101YM0800X | Mental Health Counselor | ||
N | 104100000X | Social Worker | ||
Y | 1041C0700X | Clinical Social Worker | SW3871 | FL |
NPI | 1003391327 |
---|---|
Provider Name | Dr. Mark J Macgowan |
First Address | Palmetto Bay, FL 33158-1722 |
Second Address | Palmetto Bay, FL 33158-1722 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2018 |
Last Update Date | 08/10/2018 |