Provider Demographics
NPI:1982993408
Name:HORAN, THOMAS JEROME
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JEROME
Last Name:HORAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2608 NE 33RD ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1516
Mailing Address - Country:US
Mailing Address - Phone:305-796-2269
Mailing Address - Fax:
Practice Address - Street 1:650 BOULEVARD AVE
Practice Address - Street 2:
Practice Address - City:DICKSON CITY
Practice Address - State:PA
Practice Address - Zip Code:18519-1710
Practice Address - Country:US
Practice Address - Phone:570-383-2799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005807L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist