Provider Demographics
NPI:1255060018
Name:OHEARN PSYCHOLOGICAL SERVICES PLLC
Entity type:Organization
Organization Name:OHEARN PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:OHEARN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:585-820-1573
Mailing Address - Street 1:620 PARK AVE # 113
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-2943
Mailing Address - Country:US
Mailing Address - Phone:585-820-1573
Mailing Address - Fax:
Practice Address - Street 1:74 MEADOWBROOK RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-3030
Practice Address - Country:US
Practice Address - Phone:585-820-1573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty