Provider Demographics
NPI:1225465370
Name:MCCANN, JUDY ELINOR (MS)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:ELINOR
Last Name:MCCANN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 MAIN ST
Mailing Address - Street 2:APARTMENT 2
Mailing Address - City:MANNS CHOICE
Mailing Address - State:PA
Mailing Address - Zip Code:15550-9014
Mailing Address - Country:US
Mailing Address - Phone:814-979-0120
Mailing Address - Fax:
Practice Address - Street 1:10565 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:PA
Practice Address - Zip Code:15537-7047
Practice Address - Country:US
Practice Address - Phone:814-623-2220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101YP2500X101YP2500X
PA103K0000X103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst