Provider Demographics
NPI:1437162823
Name:QUEENAN, PATRICK LYDON (PHD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:LYDON
Last Name:QUEENAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 FEDERAL RD
Mailing Address - Street 2:SUITE 319
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-2418
Mailing Address - Country:US
Mailing Address - Phone:203-775-4915
Mailing Address - Fax:
Practice Address - Street 1:304 FEDERAL RD
Practice Address - Street 2:SUITE 319
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-2418
Practice Address - Country:US
Practice Address - Phone:203-775-4915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002395103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical