Provider Demographics
NPI:1588843197
Name:PRITCHARD, MARLENE A
Entity Type:Individual
Prefix:MRS
First Name:MARLENE
Middle Name:A
Last Name:PRITCHARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 OLD NATIONAL PIKE
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15333-2114
Mailing Address - Country:US
Mailing Address - Phone:724-632-6801
Mailing Address - Fax:724-632-6312
Practice Address - Street 1:190 BONAR AVE
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-1604
Practice Address - Country:US
Practice Address - Phone:724-627-8156
Practice Address - Fax:724-852-1412
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0180161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007288440093Medicaid
PA328834A764918OtherVALUE BEHAVIORAL HEALTH