Provider Demographics
NPI:1780645747
Name:MCHUGH, PATRICK J (PHD)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:J
Last Name:MCHUGH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 N PROVIDENCE RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-1235
Mailing Address - Country:US
Mailing Address - Phone:610-565-1399
Mailing Address - Fax:
Practice Address - Street 1:1223 N PROVIDENCE RD
Practice Address - Street 2:SUITE 3
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-1235
Practice Address - Country:US
Practice Address - Phone:610-565-1399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002744L103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1400277Medicaid
PA075811OtherBS
075811Medicare ID - Type Unspecified