Healthcare Provider Details

I. General information

NPI: 1821166315
Provider Name (Legal Business Name): BRENNA CATHLEEN MCDONALD PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 BARNHILL DR EH 125
INDIANAPOLIS IN
46202-5112
US

IV. Provider business mailing address

545 BARNHILL DR EH 125
INDIANAPOLIS IN
46202-5112
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-8800
  • Fax: 317-274-2384
Mailing address:
  • Phone: 317-274-8800
  • Fax: 317-274-2384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number985
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number20042155A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number20042155A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: