Provider Demographics
NPI:1477849230
Name:O HALLORAN, MARIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:O HALLORAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:COLETTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:506 W MOUNT AIRY AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-2948
Mailing Address - Country:US
Mailing Address - Phone:610-237-5676
Mailing Address - Fax:
Practice Address - Street 1:1503 LANSDOWNE AVE
Practice Address - Street 2:MERCY WELLNESS CENTER STE 3008.
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-1330
Practice Address - Country:US
Practice Address - Phone:610-237-5676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016726103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist