Provider Demographics
NPI:1982762886
Name:DONAHUE, KATHLEEN A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:A
Last Name:DONAHUE
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 1:31 BROCKWAY PL
Mailing Address - Street 2:
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420-2207
Mailing Address - Country:US
Mailing Address - Phone:585-319-1546
Mailing Address - Fax:585-395-1887
Practice Address - Street 1:31 BROCKWAY PL
Practice Address - Street 2:
Practice Address - City:BROCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14420-2207
Practice Address - Country:US
Practice Address - Phone:585-319-1546
Practice Address - Fax:585-395-1887
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012973-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7059494OtherAETNA
NY179887FCOtherPREFERRED CARE
NY6111459OtherINDEPENDENT HEALTH
NY0002627690OtherFIDELIS
NY00026276901OtherUNIVERA
NY01777173Medicaid
NY000525385001OtherBCBS OF WESTERN NY
NY000525385001OtherBCBS OF WESTERN NY