Healthcare Provider Details

I. General information

NPI: 1336207570
Provider Name (Legal Business Name): PATRICK S. HANNA PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4108 ZUCK RD
ERIE PA
16506-4539
US

IV. Provider business mailing address

4108 ZUCK RD
ERIE PA
16506-4539
US

V. Phone/Fax

Practice location:
  • Phone: 814-833-6898
  • Fax: 814-835-0019
Mailing address:
  • Phone: 814-833-6898
  • Fax: 814-835-0019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS005026L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: