Provider Demographics
NPI:1891093324
Name:BROGAN, MARY ELLEN (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:MARY ELLEN
Middle Name:
Last Name:BROGAN
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 GREYHORSE RD
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1607
Mailing Address - Country:US
Mailing Address - Phone:203-249-7664
Mailing Address - Fax:
Practice Address - Street 1:150 GREYHORSE RD
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1607
Practice Address - Country:US
Practice Address - Phone:203-249-7664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2019-10-23
Deactivation Date:2015-10-07
Deactivation Code:
Reactivation Date:2019-10-10
Provider Licenses
StateLicense IDTaxonomies
PASW126825104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker