Provider Demographics
NPI:1043803653
Name:MCGOVERN, MARCELLE LOUISE (LSW, MSW)
Entity type:Individual
Prefix:
First Name:MARCELLE
Middle Name:LOUISE
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:LSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 KETTERER CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2855
Mailing Address - Country:US
Mailing Address - Phone:908-839-8002
Mailing Address - Fax:
Practice Address - Street 1:105 KETTERER CT
Practice Address - Street 2:
Practice Address - City:LAWRENCE TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08648-2855
Practice Address - Country:US
Practice Address - Phone:908-839-8002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-15
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06432200104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker