Provider Demographics
NPI:1811017932
Name:K M DOHENY PC
Entity Type:Organization
Organization Name:K M DOHENY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:DOHENY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:312-409-0899
Mailing Address - Street 1:635 W WRIGHTWOOD AVE
Mailing Address - Street 2:UNIT 5
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-6283
Mailing Address - Country:US
Mailing Address - Phone:312-409-0899
Mailing Address - Fax:773-472-1639
Practice Address - Street 1:307 N MICHIGAN AVE
Practice Address - Street 2:SUITE 802
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-5311
Practice Address - Country:US
Practice Address - Phone:312-409-0899
Practice Address - Fax:773-472-1639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty