Provider Demographics
NPI:1467501213
Name:HOLLERAN, JOHN PAUL (EDD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PAUL
Last Name:HOLLERAN
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WOODBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-3144
Mailing Address - Country:US
Mailing Address - Phone:781-749-4580
Mailing Address - Fax:
Practice Address - Street 1:62 DERBY ST
Practice Address - Street 2:SUITE 15
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-3728
Practice Address - Country:US
Practice Address - Phone:781-740-8213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPY 3148103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA726454Medicare UPIN
MAW50934Medicare ID - Type Unspecified
MAW03209Medicare UPIN