Broc A McGowan, LCSW
Individual provider Active NPI Clinical Social Worker · Cornville, ME
NPI 1275810475 · NPPES record last updated Jul 16, 2024
Key facts
- NPI
- 1275810475
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- LC22280 (ME)
- Practice address
- 750 Molunkus Rd
Cornville, ME 04976-6116 - Phone
- (207) 431-5801
- NPI assigned
- Nov 16, 2011
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LC22280 | ME | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Solid Ground Counseling, LLC | Clinical | Current |
Accepting new patients |
| Penquis C.a.P., Inc. | Past | Accepting new patients |
Interoperability endpoints
- broc.mcgowan@1027816006877188.direct.elationemr.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LC22280 | ME | Yes |
Addresses
Primary practice location
750 Molunkus Rd
Cornville, ME 04976-6116
Mailing address
750 Molunkus Rd
Cornville, ME 04976-6116
Phone (207) 431-5801
Other providers in Cornville, ME
- Jenny Andre
- Mary Rose Callain
- Community Regional Charter School
- Linda Gale Drake
- Frederick Allen
- Abbie Richardson
- Solid Ground Counseling, LLC
All providers in Cornville, ME · Clinical Social Worker in Maine
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 16, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.