Provider Demographics
NPI:1538143326
Name:HANNIFAN, JOHN JOSEPH (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JOSEPH
Last Name:HANNIFAN
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 1:308 N MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-1846
Mailing Address - Country:US
Mailing Address - Phone:270-765-5043
Mailing Address - Fax:270-769-5654
Practice Address - Street 1:308 N MULBERRY ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-1846
Practice Address - Country:US
Practice Address - Phone:270-765-5043
Practice Address - Fax:270-769-5654
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY0256103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77272OtherCIGNA HEALTH CARE
KYPVPB136788OtherAMERICAN PSYCH SYSTEMS
KY6135352OtherUNITED HEALTHCARE
KY207474OtherCOMP PSYCH
KY022450OtherHORIZON BEHAVIORAL HEALTH
KY036557000OtherMAGELLAN BEHAVIORAL HEALT
KY29201068OtherIMPACT PLUS-DCBS
KY89002562Medicaid
KY29101060OtherIMPACT PLUS-DMH
KY873663OtherUSA MANAGED CARE
KY000000047088OtherANTHEM BC/BS
KY092987OtherMANAGED HEALTH NETWORK
KY6135352OtherUNITED BEHAVIORAL HEALTH
KY044662OtherVALUE OPTIONS
KY63617OtherMENTAL HEALTH NET
KY70778OtherCMG
KYHUKY0729OtherHUMANA
KY036557000OtherMAGELLAN BEHAVIORAL HEALT
KY207474OtherCOMP PSYCH