Provider Demographics
NPI:1275745952
Name:ELMENDORF, DONNA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:M
Last Name:ELMENDORF
Suffix:
Gender:F
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:PO BOX 32
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01262-0032
Mailing Address - Country:US
Mailing Address - Phone:413-298-4439
Mailing Address - Fax:413-298-4020
Practice Address - Street 1:25 MAIN STREET
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01262-0962
Practice Address - Country:US
Practice Address - Phone:413-931-5248
Practice Address - Fax:413-298-4020
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6827103T00000X
NY011688103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist