Basic Information
| Provider Information | |||||||||
| NPI: | 1770080186 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CONDON | ||||||||
| FirstName: | LIAM | ||||||||
| MiddleName: | PATRICK | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 65 PROFESSIONAL PL STE 102103 | ||||||||
| Address2: | |||||||||
| City: | BRIDGEPORT | ||||||||
| State: | WV | ||||||||
| PostalCode: | 263300258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3048485770 | ||||||||
| FaxNumber: | 3048480890 | ||||||||
| Practice Location | |||||||||
| Address1: | 65 PROFESSIONAL PL STE 102103 | ||||||||
| Address2: | |||||||||
| City: | BRIDGEPORT | ||||||||
| State: | WV | ||||||||
| PostalCode: | 263300258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3048485770 | ||||||||
| FaxNumber: | 3048480890 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2018 | ||||||||
| LastUpdateDate: | 08/31/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 08/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 1188 | WV | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.