Provider Demographics
NPI:1396755963
Name:MCDONOUGH, MARY PATRICIA (LISW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:PATRICIA
Last Name:MCDONOUGH
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 DOROTHY ST
Mailing Address - Street 2:APT. R-4
Mailing Address - City:EAST PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15112-1364
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:VA PHCS
Practice Address - Street 2:UNIVERSITY DRIVE C, PRIMARY CARE 1ST FLOOR 130-U
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15240
Practice Address - Country:US
Practice Address - Phone:412-688-6645
Practice Address - Fax:412-688-6290
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1241121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical