Provider Demographics
NPI:1043572175
Name:MCLOUGHLIN, PENNY SARAH
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:SARAH
Last Name:MCLOUGHLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:DOBBS FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:10522-1118
Mailing Address - Country:US
Mailing Address - Phone:914-693-7677
Mailing Address - Fax:914-693-0386
Practice Address - Street 1:535 BROADWAY
Practice Address - Street 2:
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522-1118
Practice Address - Country:US
Practice Address - Phone:914-693-7677
Practice Address - Fax:914-693-0386
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator