Provider Demographics
NPI:1336445691
Name:DONOHUE, KELLI ANN (PHD)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:ANN
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 1:10300 SHORE FRONT PKWY
Mailing Address - Street 2:APT 10S
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-2788
Mailing Address - Country:US
Mailing Address - Phone:917-535-7605
Mailing Address - Fax:
Practice Address - Street 1:163 PROSPECT PARK W
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-5271
Practice Address - Country:US
Practice Address - Phone:347-993-0325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018980103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist