Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PS-006761-L | PA |
N | 103G00000X | Clinical Psychologist | PS-006761-L | PA |
N | 103TC0700X | Clinical Psychologist | PS-006761-L | PA |
NPI | 1255319794 |
---|---|
Provider Name | Dr. Michael J. Dolan |
First Address | Bethlehem, PA 18017-2731 |
Second Address | Allentown, PA 18104-1351 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01401801 | BLUE CROSS (01) | PA |
D01781737 | HIGHMARK BLUE SHEILD (01) | PA |
D3549655 | OXFORD PLAN (01) | PA |