Healthcare Provider Details

I. General information

NPI: 1992349708
Provider Name (Legal Business Name): PATRICK MCDONOUGH LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2019
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MULBERRY ST STE 201
SCRANTON PA
18503-1233
US

IV. Provider business mailing address

2126 JEFFERSON AVE
DUNMORE PA
18509-1527
US

V. Phone/Fax

Practice location:
  • Phone: 570-955-5479
  • Fax:
Mailing address:
  • Phone: 570-985-5075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW136176
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: