Provider Demographics
NPI:1598850661
Name:FINNEGAN, KATHLEEN M (PHD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:FINNEGAN
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 1:3872 E HARBOR LIGHT LANDING DR
Mailing Address - Street 2:SUITE 316
Mailing Address - City:PORT CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:43452-3877
Mailing Address - Country:US
Mailing Address - Phone:419-734-3333
Mailing Address - Fax:877-734-2030
Practice Address - Street 1:3619 PARK EAST DR
Practice Address - Street 2:SUITE 316
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4330
Practice Address - Country:US
Practice Address - Phone:216-591-0500
Practice Address - Fax:216-591-0550
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5020103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000137844OtherANTHEM
OH0182369Medicaid
OH294505000OtherMAGELLAN
OH620003454OtherRAILROAD MEDICARE
OHCP17811Medicare ID - Type Unspecified