Healthcare Provider Details

I. General information

NPI: 1558436477
Provider Name (Legal Business Name): PAUL JOSEPH DONOGHUE PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

363 OCEAN DR W
STAMFORD CT
06902-8222
US

IV. Provider business mailing address

363 OCEAN DR W
STAMFORD CT
06902-8222
US

V. Phone/Fax

Practice location:
  • Phone: 203-324-7889
  • Fax: 203-921-1656
Mailing address:
  • Phone: 203-324-7889
  • Fax: 203-921-1656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number000520
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: