Provider Demographics
NPI:1285653691
Name:CHIMERA, DONNA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:M
Last Name:CHIMERA
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 1:3 SPRUCE CT
Mailing Address - Street 2:
Mailing Address - City:NORTH BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-2745
Mailing Address - Country:US
Mailing Address - Phone:516-377-3345
Mailing Address - Fax:
Practice Address - Street 1:3 SPRUCE CT
Practice Address - Street 2:
Practice Address - City:NORTH BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-2745
Practice Address - Country:US
Practice Address - Phone:516-377-3345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9297103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0013512OtherVALUE OPTIONS - GHI
NY0013512OtherVALUE OPTIONS - GHI