Provider Demographics
NPI:1497390298
Name:DONOHUE, KEITH FRANCIS (PHD, LP)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:FRANCIS
Last Name:DONOHUE
Suffix:
Gender:M
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 FREEDOM WAY
Mailing Address - Street 2:
Mailing Address - City:HOPKINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01748-2888
Mailing Address - Country:US
Mailing Address - Phone:701-200-7156
Mailing Address - Fax:
Practice Address - Street 1:25 BIRCH ST STE A6
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-3585
Practice Address - Country:US
Practice Address - Phone:781-551-0999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-15
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND576103TC0700X
MNLP6456103T00000X, 103TC0700X
MA11865103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1497390298Medicaid
ND1479308Medicaid