Provider Demographics
NPI:1861934580
Name:NOLAN, GERALD PATRICK (MS, CAP)
Entity type:Individual
Prefix:MR
First Name:GERALD
Middle Name:PATRICK
Last Name:NOLAN
Suffix:
Gender:M
Credentials:MS, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 SE 19TH AVE
Mailing Address - Street 2:APT A
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-5062
Mailing Address - Country:US
Mailing Address - Phone:860-834-0228
Mailing Address - Fax:
Practice Address - Street 1:380 SE 19TH AVE
Practice Address - Street 2:APT A
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-5062
Practice Address - Country:US
Practice Address - Phone:860-834-0228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-11
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)