Provider Demographics
NPI:1942557665
Name:MCGOVERN, ANDREW AUGUSTUS
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:AUGUSTUS
Last Name:MCGOVERN
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ANDREW
Other - Middle Name:AUGUSTUS
Other - Last Name:MCGOVERN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:TRANQUILITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07879-0129
Mailing Address - Country:US
Mailing Address - Phone:973-722-2831
Mailing Address - Fax:
Practice Address - Street 1:33 KENNEDY RD
Practice Address - Street 2:STE 33A
Practice Address - City:ANDOVER
Practice Address - State:NJ
Practice Address - Zip Code:07821
Practice Address - Country:US
Practice Address - Phone:973-722-2831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00494600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ37PC 00494600OtherINDIVIDUAL