Provider Demographics
NPI:1023280732
Name:MCGOWAN, MARK RAYMOND (PHD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:RAYMOND
Last Name:MCGOWAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1176 GRANT ST
Mailing Address - Street 2:SUITE 2220
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-2870
Mailing Address - Country:US
Mailing Address - Phone:724-599-4300
Mailing Address - Fax:724-357-6946
Practice Address - Street 1:1176 GRANT ST
Practice Address - Street 2:SUITE 2220
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-2870
Practice Address - Country:US
Practice Address - Phone:724-599-4300
Practice Address - Fax:724-357-6946
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2010-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAPS016568103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist