Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PS-008949-L | PA |
Y | 103T00000X | Psychologist | PS-008949-L | PA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PS-008949-L | PA |
N | 103G00000X | Clinical Psychologist | PS-008949-L | PA |
N | 103TC0700X | Clinical Psychologist | PS-008949-L | PA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PS-008949-L | PA |
N | 103TF0000X | Family Psychologist | PS-008949-L | PA |
N | 103TH0004X | Health Psychologist | PS-008949-L | PA |
N | 103TH0100X | Health Service | PS-008949-L | PA |
N | 103TM1800X | Intellectual & Developmental Disabilities | PS-008949-L | PA |
N | 103TR0400X | Rehabilitation Psychologist | PS-008949-: | PA |
NPI | 1437306651 |
---|---|
Provider Name | Dr. Patrick Progar |
First Address | Medford, NJ 08055-8333 |
Second Address | Coatesville, PA 19320-1714 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2008 |
Last Update Date | 19/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PS-008949-L | PENNSYLVANIA LICENSE TO PRACTICE PSYCHOLOGY (01) | PA |