Provider Demographics
NPI:1477750677
Name:MCNAMARA, KATHLEEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:MCNAMARA
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 1:333 W DRAKE RD
Mailing Address - Street 2:SUITE 280
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-6320
Mailing Address - Country:US
Mailing Address - Phone:970-207-0278
Mailing Address - Fax:
Practice Address - Street 1:333 W DRAKE RD
Practice Address - Street 2:SUITE 280
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-6320
Practice Address - Country:US
Practice Address - Phone:970-207-0278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1127103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist