George William Deegan, PSW874

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

PSW874 Issued in FL

Practice address

306 Union Ave
Crescent City, FL 32112-4432

Phone

(386) 698-1232

Fax

(386) 698-4154

NPI assigned

Oct 24, 2012

Last updated

Oct 24, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: george.deegan.p1@direct.azahealth.nextgenshare.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1351036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1351036800000",
    "number": "1841543147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "306 UNION AVE",
            "city": "CRESCENT CITY",
            "state": "FL",
            "postal_code": "321124432",
            "telephone_number": "386-698-1232",
            "fax_number": "386-698-4154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 UNION AVE",
            "city": "CRESCENT CITY",
            "state": "FL",
            "postal_code": "321124432",
            "telephone_number": "386-698-1232",
            "fax_number": "386-698-4154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEEGAN",
        "first_name": "GEORGE",
        "middle_name": "WILLIAM",
        "name_prefix": "Mr.",
        "credential": "PSW874",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-10-24",
        "last_updated": "2012-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "FL",
            "license": "5565",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NY",
            "license": "1905",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "PSW874",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "72072418",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Crescent City, FL
• Providers in Crescent City, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.