Provider Demographics
NPI:1710167747
Name:ADDISON, ALAN ROBERT (BA/MA-PHD)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:ROBERT
Last Name:ADDISON
Suffix:
Gender:M
Credentials:BA/MA-PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 INTERNATIONAL LN
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-8804
Mailing Address - Country:US
Mailing Address - Phone:205-495-7171
Mailing Address - Fax:
Practice Address - Street 1:1055 INTERNATIONAL LANE
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-1337
Practice Address - Country:US
Practice Address - Phone:205-495-7171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL101YM0800X, 171M00000X
FL11435101YP1600X
PA222Q00000X
MA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No374U00000XNursing Service Related ProvidersHome Health Aide