Provider Demographics
NPI:1689622235
Name:GREADY, PATRICIA A (PSYD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:GREADY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANHEIM
Mailing Address - State:PA
Mailing Address - Zip Code:17545-1602
Mailing Address - Country:US
Mailing Address - Phone:717-665-2675
Mailing Address - Fax:717-665-6193
Practice Address - Street 1:108 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MANHEIM
Practice Address - State:PA
Practice Address - Zip Code:17545-1602
Practice Address - Country:US
Practice Address - Phone:717-665-2675
Practice Address - Fax:717-665-6193
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017208103T00000X
CT002865103TC0700X
PAPS017644103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02903506Medicaid
NYV325406261Medicare PIN