Provider Demographics
NPI:1356588032
Name:MCCULLOUGH, PATRICIA ANN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANN
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 FRENCHVILLE RD
Mailing Address - Street 2:
Mailing Address - City:FRENCHVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16836-8850
Mailing Address - Country:US
Mailing Address - Phone:814-761-1621
Mailing Address - Fax:
Practice Address - Street 1:215 E LOCUST ST
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-2422
Practice Address - Country:US
Practice Address - Phone:814-761-1621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-16
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW-013007-L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker