Provider Demographics
NPI:1962846048
Name:MCCOLE, MARY T (LCSW, CAS-PC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:T
Last Name:MCCOLE
Suffix:
Gender:F
Credentials:LCSW, CAS-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 W TOWNSHIP LINE RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-5237
Mailing Address - Country:US
Mailing Address - Phone:484-453-8185
Mailing Address - Fax:610-537-5043
Practice Address - Street 1:410 W TOWNSHIP LINE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-5237
Practice Address - Country:US
Practice Address - Phone:484-453-8185
Practice Address - Fax:610-537-5043
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-19
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0141101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical