Provider Demographics
NPI:1568845345
Name:KAREN B DONAHUE, PSYD LLC
Entity Type:Organization
Organization Name:KAREN B DONAHUE, PSYD LLC
Other - Org Name:KAREN B DONAHUE, MA LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:BOYLE
Authorized Official - Last Name:DONAHUE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:732-528-5553
Mailing Address - Street 1:1540 ROUTE 138
Mailing Address - Street 2:BUILDING 2, SUITE 201
Mailing Address - City:WALL
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-3763
Mailing Address - Country:US
Mailing Address - Phone:732-528-5553
Mailing Address - Fax:732-515-9159
Practice Address - Street 1:1540 ROUTE 138
Practice Address - Street 2:BUILDING 2, SUITE 201
Practice Address - City:WALL
Practice Address - State:NJ
Practice Address - Zip Code:07719-3763
Practice Address - Country:US
Practice Address - Phone:732-528-5553
Practice Address - Fax:732-556-0246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-30
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00538000103G00000X, 103TB0200X, 103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty