Provider Demographics
NPI:1245805068
Name:DONOGHUE, TARA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:
Last Name:DONOGHUE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18003 SKY PARK CIR STE H2
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-6526
Mailing Address - Country:US
Mailing Address - Phone:949-228-7143
Mailing Address - Fax:
Practice Address - Street 1:18003 SKY PARK CIR STE H2
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6526
Practice Address - Country:US
Practice Address - Phone:949-464-8272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-24
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32663103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty