Provider Demographics
NPI:1669848446
Name:MCLAUGHLIN-GOMBEDA, MARA (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:MARA
Middle Name:
Last Name:MCLAUGHLIN-GOMBEDA
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 1:223 WEST BROAD ST
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201
Mailing Address - Country:US
Mailing Address - Phone:570-455-9902
Mailing Address - Fax:570-455-9452
Practice Address - Street 1:223 W BROAD ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-6201
Practice Address - Country:US
Practice Address - Phone:570-455-9902
Practice Address - Fax:570-455-9452
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0184221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical