Doctor Name: | JEAN M MCNALLY |
NPI Number: | 1215075015 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | ASW |
License Number: | ASW 36990 |
Business Practice Address: | 750 Old Lucerne Rd Upper Lake, CA - 954858755 |
Business Phone Number: | 7072758166 |
Business Fax Number: | 7072758168 |
Mailing Address: | 5807 Huron Ave, CLEARLAKE |
State: | CA |
Postal Code: | 954229086 |
Phone Number: | 7079951002 |
Fax Number: | |
NPI Enumeration Date: | 02/02/2007 |
NPI Last Update Date: | 11/15/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | ASW 36990 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |