Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PS007781L | PA |
N | 103T00000X | Psychologist | PS007781L | PA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PS007781L | PA |
N | 103TM1800X | Intellectual & Developmental Disabilities | PS007781L | PA |
Y | 103TS0200X | School Psychologist | PS007781L | PA |
NPI | 1174007462 |
---|---|
Provider Name | Dr. Nancy Jo Patrick |
First Address | Harrisburg, PA 17112-8876 |
Second Address | Harrisburg, PA 17112-6257 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2018 |
Last Update Date | 21/09/2018 |