Provider Demographics
NPI:1780205807
Name:DONOVAN, KERA L (PHD)
Entity type:Individual
Prefix:
First Name:KERA
Middle Name:L
Last Name:DONOVAN
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 1:9 CHERRY DR NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-5302
Mailing Address - Country:US
Mailing Address - Phone:330-333-1679
Mailing Address - Fax:
Practice Address - Street 1:9 CHERRY DR NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-5302
Practice Address - Country:US
Practice Address - Phone:330-333-1679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty