Provider Demographics
NPI:1689030504
Name:DONAHUE, KAREN BOYLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:BOYLE
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 1:1540 ROUTE 138
Mailing Address - Street 2:BLDG 2, SUITE 201
Mailing Address - City:WALL TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-3763
Mailing Address - Country:US
Mailing Address - Phone:732-528-5553
Mailing Address - Fax:732-515-9159
Practice Address - Street 1:1540 ROUTE 138
Practice Address - Street 2:BLDG 2, SUITE 201
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07719-3763
Practice Address - Country:US
Practice Address - Phone:732-528-5553
Practice Address - Fax:732-515-9159
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-07
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00538000103G00000X, 103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral