Provider Demographics
NPI:1508853995
Name:O'DONNELL, PETER JOSEPH (PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:JOSEPH
Last Name:O'DONNELL
Suffix:
Gender:M
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 E BISHOP ST
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTE
Mailing Address - State:PA
Mailing Address - Zip Code:16823-1944
Mailing Address - Country:US
Mailing Address - Phone:814-355-8215
Mailing Address - Fax:
Practice Address - Street 1:615 HOWARD AVE
Practice Address - Street 2:STE 214
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4813
Practice Address - Country:US
Practice Address - Phone:814-355-8215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2019-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002531101Y00000X
PAPS006518L103G00000X, 103TH0100X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service