Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | 002084 | CT |
Y | 103G00000X | Clinical Psychologist | 002084 | CT |
Y | 103TC0700X | Clinical Psychologist | 002084 | CT |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 002084 | CT |
NPI | 1043547763 |
---|---|
Provider Name | Dr. Kim Marie O'donnell |
First Address | Cheshire, CT 06410-2808 |
Second Address | Cheshire, CT 06410-2808 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2009 |
Last Update Date | 17/11/2009 |