Basic Information
Provider Information | |||||||||
NPI: | 1558732784 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MCGANN | ||||||||
FirstName: | KATHLEEN | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PSY.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | MCGANN | ||||||||
OtherFirstName: | KATIE | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | PSY.D. | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 100 E LANCASTER AVE STE B11 | ||||||||
Address2: |   | ||||||||
City: | WYNNEWOOD | ||||||||
State: | PA | ||||||||
PostalCode: | 190963450 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4844762658 | ||||||||
FaxNumber: | 4844763577 | ||||||||
Practice Location | |||||||||
Address1: | 100 E LANCASTER AVE STE B11 | ||||||||
Address2: |   | ||||||||
City: | WYNNEWOOD | ||||||||
State: | PA | ||||||||
PostalCode: | 190963450 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4844762658 | ||||||||
FaxNumber: | 4844763577 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/14/2015 | ||||||||
LastUpdateDate: | 03/03/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/03/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PS019177 | PA | Y |   | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.