Doctor Name: | KATHERINE ELIZABETH DONNELLY |
NPI Number: | 1538416383 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PSY.D. |
License Number: | PY8182 |
Business Practice Address: | 7487 S State Road 121 Macclenny, FL - 320635451 |
Business Phone Number: | 9042596211 |
Business Fax Number: | |
Mailing Address: | 7777 Normandy Blvd, Apt 621 JACKSONVILLE |
State: | FL |
Postal Code: | 322217659 |
Phone Number: | 9789790849 |
Fax Number: | |
NPI Enumeration Date: | 08/11/2012 |
NPI Last Update Date: | 08/11/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | PY8182 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |