Healthcare Provider Details

I. General information

NPI: 1073718086
Provider Name (Legal Business Name): DONNA M PHAIR PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 ALLAIRE AVE
MIDDLETOWN NJ
07748
US

IV. Provider business mailing address

5 ALLAIRE AVE
MIDDLETOWN NJ
07748
US

V. Phone/Fax

Practice location:
  • Phone: 732-865-3272
  • Fax: 732-796-9875
Mailing address:
  • Phone: 732-865-3272
  • Fax: 732-796-9875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberNJ35SI00512600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number019556-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: