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NPI Code Detail

MEDICARE: RITA MARIE DONOGHUE MS

MEDICARE: RITA MARIE DONOGHUE MS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11-15-18803OTHERINBCBA

General Provider Information

NPI Number : 1760731475
Entity Type Code : Individual
Provider Name (Legal Business Name) : RITA MARIE DONOGHUE MS
Provider Business Mailing Address
First Line : 3500 DEPAUW BLVD STE 3070
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46268-6135
Country : US
Telephone Number : 855-324-0885
Fax Number : 765-454-9759
Provider Business Practice Location Address
First Line : 6635 E 21ST ST STE 100
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46219-2252
Country : US
Telephone Number : 317-608-2824
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/10/2012
Last Update Date : 03/13/2024

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Directions to “ RITA MARIE DONOGHUE MS” Practice Location

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