Provider Demographics
NPI:1437318714
Name:MCCAW, KATHY E (MA)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:E
Last Name:MCCAW
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1464 ROUTE 61 HWY S
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-8408
Mailing Address - Country:US
Mailing Address - Phone:570-789-4608
Mailing Address - Fax:570-581-8089
Practice Address - Street 1:1464 ROUTE 61 HWY S
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-8408
Practice Address - Country:US
Practice Address - Phone:570-789-4608
Practice Address - Fax:570-581-8089
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
PAMF000602106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor