Provider Demographics
NPI:1841209103
Name:MCCORKLE, WENDY E (LCSW)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:E
Last Name:MCCORKLE
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 1:1382 OLD FREEPORT RD
Mailing Address - Street 2:SUITE 2AF
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-3159
Mailing Address - Country:US
Mailing Address - Phone:412-963-7956
Mailing Address - Fax:
Practice Address - Street 1:1382 OLD FREEPORT RD
Practice Address - Street 2:SUITE 2AF
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-3159
Practice Address - Country:US
Practice Address - Phone:412-963-7956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2008-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW009465L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000628075OtherBLUE SHIELD NUMBER
PA205493OtherUPMC NUMBER