Provider Demographics
NPI:1235250572
Name:DONSON, KATHLEEN MAURA (MSW,LCSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MAURA
Last Name:DONSON
Suffix:
Gender:F
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1869 ROUTE 739 STE 1
Mailing Address - Street 2:
Mailing Address - City:DINGMANS FERRY
Mailing Address - State:PA
Mailing Address - Zip Code:18328-3409
Mailing Address - Country:US
Mailing Address - Phone:570-687-6830
Mailing Address - Fax:
Practice Address - Street 1:1869 SUITE 1 ROUTE 739
Practice Address - Street 2:
Practice Address - City:DINGMANS FERRY
Practice Address - State:PA
Practice Address - Zip Code:18328-3409
Practice Address - Country:US
Practice Address - Phone:570-687-6830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0160561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102700996Medicaid