Provider Demographics
NPI:1871710103
Name:EGAN, MAUREEN G (LICSW)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:G
Last Name:EGAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:282 BALSAM RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02879-4923
Mailing Address - Country:US
Mailing Address - Phone:401-789-2150
Mailing Address - Fax:
Practice Address - Street 1:101 FRIENDSHIP ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-3716
Practice Address - Country:US
Practice Address - Phone:401-528-3763
Practice Address - Fax:401-528-3870
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW008251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical