Provider Demographics
NPI:1215112586
Name:MCINTOSH, MARY (LCSW, BCBA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:LCSW, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 ORCHARD BEACH RD
Mailing Address - Street 2:
Mailing Address - City:NORTH EAST
Mailing Address - State:PA
Mailing Address - Zip Code:16428-3107
Mailing Address - Country:US
Mailing Address - Phone:814-572-4708
Mailing Address - Fax:
Practice Address - Street 1:2221 PENINSULA DR STE A
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-2954
Practice Address - Country:US
Practice Address - Phone:814-572-4708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0152261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical