Provider Demographics
NPI:1962607481
Name:O'GORMAN, PATRICIA A (PHD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:O'GORMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3316 COUNTY ROUTE 9
Mailing Address - Street 2:
Mailing Address - City:EAST CHATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12060-1706
Mailing Address - Country:US
Mailing Address - Phone:518-392-3845
Mailing Address - Fax:518-392-4521
Practice Address - Street 1:92 FRISBEE ST
Practice Address - Street 2:
Practice Address - City:EAST CHATHAM
Practice Address - State:NY
Practice Address - Zip Code:12060-3201
Practice Address - Country:US
Practice Address - Phone:518-392-3845
Practice Address - Fax:518-392-4521
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005084103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6894434OtherGHI
NY6894434OtherGHI