Provider Demographics
NPI:1740290840
Name:THACHER, ELLEN S (LCSW)
Entity type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:S
Last Name:THACHER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:SHELLEY
Other - Middle Name:S
Other - Last Name:THACHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:10475 PERRY HWY
Mailing Address - Street 2:TOWN CENTRE, STE 300
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9274
Mailing Address - Country:US
Mailing Address - Phone:724-759-7500
Mailing Address - Fax:724-759-7600
Practice Address - Street 1:10475 PERRY HWY
Practice Address - Street 2:TOWN CENTRE, STE 300
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9274
Practice Address - Country:US
Practice Address - Phone:724-759-7500
Practice Address - Fax:724-759-7600
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW013668104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker