Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | PC002531 | PA |
N | 103G00000X | Clinical Psychologist | PS006518L | PA |
N | 103TC0700X | Clinical Psychologist | PS006518L | PA |
Y | 103G00000X | Clinical Psychologist | PS006518L | PA |
Y | 103TC0700X | Clinical Psychologist | PS006518L | PA |
N | 103TH0100X | Health Service | PS006518L | PA |
NPI | 1508853995 |
---|---|
Provider Name | Dr. Peter Joseph O'donnell |
First Address | Bellefonte, PA 16823-1944 |
Second Address | Altoona, PA 16601-4813 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2005 |
Last Update Date | 15/09/2019 |