Provider Demographics
NPI:1639508823
Name:DOLAN, JOSHUA JAMES (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:JAMES
Last Name:DOLAN
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 1:1063 WESTPORT DR APT 245
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53074-2479
Mailing Address - Country:US
Mailing Address - Phone:262-527-4611
Mailing Address - Fax:
Practice Address - Street 1:6110 N PORT WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53217-4308
Practice Address - Country:US
Practice Address - Phone:414-962-1000
Practice Address - Fax:414-963-6866
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5020-125101YP2500X
WI3212-57103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional