Provider Demographics
NPI:1780280008
Name:HOOLAHAN, PATRICK ROBERT (PSYD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:ROBERT
Last Name:HOOLAHAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 N NEW ST APT 1F
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-5719
Mailing Address - Country:US
Mailing Address - Phone:703-999-2811
Mailing Address - Fax:
Practice Address - Street 1:35 E ELIZABETH AVE STE 26
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-6505
Practice Address - Country:US
Practice Address - Phone:610-320-2366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS019178103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty