Provider Demographics
NPI:1043003718
Name:O'HALLORAN, JACQUELINE (LCAT)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:O'HALLORAN
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 MASON CIR UNIT 220
Mailing Address - Street 2:
Mailing Address - City:BEACON
Mailing Address - State:NY
Mailing Address - Zip Code:12508-2152
Mailing Address - Country:US
Mailing Address - Phone:845-905-9842
Mailing Address - Fax:
Practice Address - Street 1:89 MASON CIR UNIT 220
Practice Address - Street 2:
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508-2152
Practice Address - Country:US
Practice Address - Phone:845-905-9842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003127102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst