Provider Demographics
NPI:1912875584
Name:MCCLATCHEY, PERSEPHONE DIANE
Entity type:Individual
Prefix:
First Name:PERSEPHONE
Middle Name:DIANE
Last Name:MCCLATCHEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PERSEPHONE
Other - Middle Name:DIANE
Other - Last Name:BINGAMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 360595
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15251-6595
Mailing Address - Country:US
Mailing Address - Phone:718-215-5311
Mailing Address - Fax:718-865-5165
Practice Address - Street 1:PO BOX 360595
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15251-6595
Practice Address - Country:US
Practice Address - Phone:718-215-5311
Practice Address - Fax:718-865-5165
Is Sole Proprietor?:No
Enumeration Date:2025-10-27
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician