Provider Demographics
NPI:1629662192
Name:MCBREARTY, PATRICK J (MED, LBS)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:MCBREARTY
Suffix:
Gender:M
Credentials:MED, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 E MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-2580
Mailing Address - Country:US
Mailing Address - Phone:717-466-6505
Mailing Address - Fax:
Practice Address - Street 1:390 E MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-2580
Practice Address - Country:US
Practice Address - Phone:717-466-6506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH000960103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst