Provider Demographics
NPI:1174647762
Name:ALTENOR, AIDAN (PHD)
Entity Type:Individual
Prefix:
First Name:AIDAN
Middle Name:
Last Name:ALTENOR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 CIRCLE DRIVE-DGS COMPLEX ANNEX
Mailing Address - Street 2:BEECHMONT BUILDING
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17105-2675
Mailing Address - Country:US
Mailing Address - Phone:717-705-8151
Mailing Address - Fax:717-705-8165
Practice Address - Street 1:32 CIRCLE DRIVE-DGS COMPLEX ANNEX
Practice Address - Street 2:BEECHMONT BUILDING
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17105-2675
Practice Address - Country:US
Practice Address - Phone:717-705-8151
Practice Address - Fax:717-705-8165
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003528L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist