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General NPI Number Information
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NPI Number | 1194067553
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Entity Type | Individual
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Provider Name | COLIN O MCENTEE LCSW
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Gender | Male
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Dates
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Enumeration Date | 03/25/2013
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Last Update Date | 01/04/2024
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Provider Practice Location Address
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Address Line | 314 MOORE BLDG
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City | UNIVERSITY PARK
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State | PA
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Zip | 16802
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Country | US
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Telephone | 814-865-2191
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Fax |
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Provider Business Mailing Address
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Address Line | 405 N 5TH ST
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City | PHILIPSBURG
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State | PA
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Zip | 16866-2324
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Country | US
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Telephone | 804-878-4788
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904009962
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW024119
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License Number State | PA
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