Provider Demographics
NPI:1720418528
Name:MONAHAN, PAUL J (MSS)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:MONAHAN
Suffix:
Gender:M
Credentials:MSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1440 RUSSELL RD
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1236
Mailing Address - Country:US
Mailing Address - Phone:610-644-6464
Mailing Address - Fax:610-981-6078
Practice Address - Street 1:107 CHESLEY DR
Practice Address - Street 2:UNIT #5
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-1760
Practice Address - Country:US
Practice Address - Phone:610-644-6464
Practice Address - Fax:610-981-6078
Is Sole Proprietor?:No
Enumeration Date:2013-11-15
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)