Provider Demographics
NPI:1578046645
Name:DONOUGHE, BRENDA DAWN
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:DAWN
Last Name:DONOUGHE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 LAKEMONT PARK BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-5967
Mailing Address - Country:US
Mailing Address - Phone:814-946-0261
Mailing Address - Fax:814-569-1189
Practice Address - Street 1:400 LAKEMONT PARK BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-5967
Practice Address - Country:US
Practice Address - Phone:814-946-0261
Practice Address - Fax:814-569-1189
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker