MEDICARE: DR. CAROLYN D DONOGHUE PH.D.

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
1	103T00000X	Psychologist	2497	OH

General Provider Information

NPI Number	:	1891917050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROLYN D DONOGHUE PH.D.

Provider Business Mailing Address
First Line	:	2212 STILLMAN RD.
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-2832
Country	:	US
Telephone Number	:	216-228-3500
Fax Number	:	216-228-5818

Provider Business Practice Location Address
First Line	:	13425 DETROIT AVENUE
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-4608
Country	:	US
Telephone Number	:	216-228-3500
Fax Number	:	216-228-5818

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	07/08/2007

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