Provider Demographics
NPI:1619229150
Name:DONOHUE, KATHLEEN M (PHD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:DONOHUE
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 1:155 BOVET RD
Mailing Address - Street 2:SUITE 404
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-3108
Mailing Address - Country:US
Mailing Address - Phone:650-918-0720
Mailing Address - Fax:
Practice Address - Street 1:155 BOVET RD
Practice Address - Street 2:SUITE 404
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-3108
Practice Address - Country:US
Practice Address - Phone:650-918-0720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19621103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent