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General NPI Number Information
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NPI Number | 1245934512
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Entity Type | Individual
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Provider Name | CATHERINE MARY VAN DAMME PSYD
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Gender | Female
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Dates
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Enumeration Date | 03/29/2023
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Last Update Date | 03/29/2023
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Provider Practice Location Address
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Address Line | 2930 E NORTHERN AVE STE A105
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City | PHOENIX
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State | AZ
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Zip | 85028-4844
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Country | US
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Telephone | 602-428-2838
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Fax |
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Provider Business Mailing Address
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Address Line | 2930 E NORTHERN AVE STE A105
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City | PHOENIX
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State | AZ
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Zip | 85028-4844
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Country | US
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Telephone | 602-428-2838
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PSY-T-000060
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License Number State | AZ
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