Provider Demographics
NPI:1205920329
Name:O DONOGHUE, CAROLINE M (PHD)
Entity type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:M
Last Name:O DONOGHUE
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 1:2555 N. PRICE RD # 1030
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224
Mailing Address - Country:US
Mailing Address - Phone:480-964-2772
Mailing Address - Fax:
Practice Address - Street 1:2555 N. PRICE RD. # 1030
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224
Practice Address - Country:US
Practice Address - Phone:480-894-2425
Practice Address - Fax:480-921-9441
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-11609101YA0400X
AZ0181101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)