MEDICARE: MR. THOMAS P. HATHAWAY LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CWO12950	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	148709	OTHER	PA	VALUE OPTIONS
2	118209	OTHER	PA	MANAGED HEALTH NETWORK
3	01100	OTHER	PA	CIGNA BEHAVIORAL HEALTH
4	55068600	OTHER	PA	MAGELLAN BEH. HEALTH
5	650376	OTHER	PA	HIGHMARK BC BS
6	202657	OTHER	PA	WESTERN BEHAVIORAL HEALTH

General Provider Information

NPI Number	:	1689652984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS P. HATHAWAY LCSW

Provider Business Mailing Address
First Line	:	1412 MOUNT ROYAL BLVD
Second Line	:	SUITE 201
City	:	GLENSHAW
State	:	PA
Zip	:	15116-2257
Country	:	US
Telephone Number	:	412-487-0949
Fax Number	:

Provider Business Practice Location Address
First Line	:	1412 MOUNT ROYAL BLVD
Second Line	:	SUITE 201
City	:	GLENSHAW
State	:	PA
Zip	:	15116-2257
Country	:	US
Telephone Number	:	412-487-0949
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	07/08/2007

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Directions to “ MR. THOMAS P. HATHAWAY LCSW” Practice Location

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