Provider Demographics
NPI:1700563640
Name:MAIN, COLLEEN ERIN (LCSW)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:ERIN
Last Name:MAIN
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 1:314 STRATFORD AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232-1149
Mailing Address - Country:US
Mailing Address - Phone:814-860-9235
Mailing Address - Fax:
Practice Address - Street 1:314 STRATFORD AVE APT 5
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-1149
Practice Address - Country:US
Practice Address - Phone:814-860-9235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0215501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical