Provider Demographics
NPI:1689652984
Name:HATHAWAY, THOMAS P (LCSW)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:P
Last Name:HATHAWAY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 MOUNT ROYAL BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GLENSHAW
Mailing Address - State:PA
Mailing Address - Zip Code:15116-2257
Mailing Address - Country:US
Mailing Address - Phone:412-487-0949
Mailing Address - Fax:
Practice Address - Street 1:1412 MOUNT ROYAL BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:GLENSHAW
Practice Address - State:PA
Practice Address - Zip Code:15116-2257
Practice Address - Country:US
Practice Address - Phone:412-487-0949
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACWO129501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA148709OtherVALUE OPTIONS
PA118209OtherMANAGED HEALTH NETWORK
PA01100OtherCIGNA BEHAVIORAL HEALTH
PA55068600OtherMAGELLAN BEH. HEALTH
PA650376OtherHIGHMARK BC BS
PA202657OtherWESTERN BEHAVIORAL HEALTH
PA55068600OtherMAGELLAN BEH. HEALTH