Provider Demographics
NPI:1821166315
Name:MCDONALD, BRENNA CATHLEEN (PSYD, MBA)
Entity Type:Individual
Prefix:DR
First Name:BRENNA
Middle Name:CATHLEEN
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:PSYD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:545 BARNHILL DR
Mailing Address - Street 2:EH 125
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5112
Mailing Address - Country:US
Mailing Address - Phone:317-274-8800
Mailing Address - Fax:317-274-2384
Practice Address - Street 1:545 BARNHILL DR
Practice Address - Street 2:EH 125
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5112
Practice Address - Country:US
Practice Address - Phone:317-274-8800
Practice Address - Fax:317-274-2384
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH985103G00000X
IN20042155A103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1009013OtherMEDICAID
NH30422169Medicaid
20889YMedicare UPIN
NH30422169Medicaid
NHRE6787Medicare ID - Type Unspecified
IN139440KKKMedicare PIN