Provider Demographics
NPI:1538613062
Name:MCCOOG, KATIE-MAUREEN HOLAHAN (LCSW)
Entity type:Individual
Prefix:
First Name:KATIE-MAUREEN
Middle Name:HOLAHAN
Last Name:MCCOOG
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 1:108 COUNTRY PLACE LN
Mailing Address - Street 2:
Mailing Address - City:WHITE HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:18661-3028
Mailing Address - Country:US
Mailing Address - Phone:570-215-8147
Mailing Address - Fax:
Practice Address - Street 1:108 COUNTRY PLACE LN
Practice Address - Street 2:
Practice Address - City:WHITE HAVEN
Practice Address - State:PA
Practice Address - Zip Code:18661-3028
Practice Address - Country:US
Practice Address - Phone:570-215-8147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-12
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0218791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical