Provider Demographics
NPI:1558345611
Name:HORAN, FREDERICK PAUL (PHD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:PAUL
Last Name:HORAN
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 1:10 COMMON ST UNIT 64
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-9203
Mailing Address - Country:US
Mailing Address - Phone:508-668-6053
Mailing Address - Fax:508-422-7297
Practice Address - Street 1:55 WEST ST STE 201
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-1837
Practice Address - Country:US
Practice Address - Phone:508-668-6053
Practice Address - Fax:508-422-7297
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4743103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW04562Medicare ID - Type Unspecified