Provider Demographics
NPI:1457335382
Name:MCGONIGLE, TAMMY Y (MSW LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:Y
Last Name:MCGONIGLE
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 PETERS DR
Mailing Address - Street 2:
Mailing Address - City:GLENSHAW
Mailing Address - State:PA
Mailing Address - Zip Code:15116-1121
Mailing Address - Country:US
Mailing Address - Phone:412-486-1456
Mailing Address - Fax:
Practice Address - Street 1:4284 RT 8 CASTLETOWN SQ S
Practice Address - Street 2:
Practice Address - City:ALLISON PARK
Practice Address - State:PA
Practice Address - Zip Code:15101
Practice Address - Country:US
Practice Address - Phone:412-486-7311
Practice Address - Fax:412-486-8402
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0138291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA050653Medicare ID - Type Unspecified