Healthcare Provider Details

I. General information

NPI: 1184833287
Provider Name (Legal Business Name): M ELAINE LOUGHLIN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: M ELAINE LOUGHLIN MSW

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 05/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E BEAVER AVE SUITE 9
STATE COLLEGE PA
16801-4922
US

IV. Provider business mailing address

129 W LINN ST
BELLEFONTE PA
16823-1639
US

V. Phone/Fax

Practice location:
  • Phone: 360-643-3589
  • Fax:
Mailing address:
  • Phone: 360-643-3589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW017677
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number00005897
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF00001407
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: