Provider Demographics
NPI:1245934512
Name:VAN DAMME, CATHERINE MARY (PSYD)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:MARY
Last Name:VAN DAMME
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 E NORTHERN AVE STE A105
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-4844
Mailing Address - Country:US
Mailing Address - Phone:602-428-2838
Mailing Address - Fax:
Practice Address - Street 1:2930 E NORTHERN AVE STE A105
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-4844
Practice Address - Country:US
Practice Address - Phone:602-428-2838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY-T-000060103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent