Provider Demographics
NPI:1558732784
Name:MCGANN, KATHLEEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:MCGANN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:MCGANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:100 E LANCASTER AVE STE B11
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3450
Mailing Address - Country:US
Mailing Address - Phone:484-476-2658
Mailing Address - Fax:484-476-3577
Practice Address - Street 1:100 E LANCASTER AVE STE B11
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:484-476-2658
Practice Address - Fax:484-476-3577
Is Sole Proprietor?:No
Enumeration Date:2015-10-14
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS019177103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical