Most Relevant Information
Provider Data
| NPI Number: | 1003391327 |
| Provider Name: | MARK J MACGOWAN PHD LCSW |
| Entity Type: | Individual |
| Taxonomy Code: | 101YA0400X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 10/02/2018 |
| Last Updated: | 10/08/2018 |
Provider Practice Location
14401 OLD CUTLER RD
PALMETTO BAY
FL
331581722
Practice Location Phone/Fax
| Phone: | 7865737010 |
| Fax: |
Provider Mailing Location
14401 OLD CUTLER RD
PALMETTO BAY
FL
331581722
Provider Mailing Phone/Fax
| Phone: | 7865737010 |
| Fax: |