Healthcare Provider Details

I. General information

NPI: 1508853995
Provider Name (Legal Business Name): PETER JOSEPH O'DONNELL PSYCHOLOGIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 09/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 HOWARD AVE STE 214
ALTOONA PA
16601-4813
US

IV. Provider business mailing address

316 E BISHOP ST
BELLEFONTE PA
16823-1944
US

V. Phone/Fax

Practice location:
  • Phone: 814-355-8215
  • Fax:
Mailing address:
  • Phone: 814-355-8215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPC002531
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPS006518L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberPS006518L
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS006518L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: