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General NPI Number Information
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NPI Number | 1548362247
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Entity Type | Individual
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Provider Name | HOLLY A CLOONAN PH.D.
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Gender | Female
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Dates
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Enumeration Date | 09/02/2006
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Last Update Date | 11/11/2016
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Provider Practice Location Address
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Address Line | 3200 MACCORKLE AVE SE FL 5
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City | CHARLESTON
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State | WV
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Zip | 25304-1227
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Country | US
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Telephone | 304-388-1000
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Fax | 304-388-1031
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Provider Business Mailing Address
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Address Line | PO BOX 7000
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City | MORGANTOWN
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State | WV
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Zip | 26507-7000
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Country | US
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Telephone | 304-347-1290
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Fax | 304-347-1397
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 445
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License Number State | WV
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