Provider Demographics
NPI:1487729836
Name:DEGEORGE, DONNA FRANCES (PHD)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:FRANCES
Last Name:DEGEORGE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12725 HOME FARM DR
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-1778
Mailing Address - Country:US
Mailing Address - Phone:303-888-2120
Mailing Address - Fax:303-255-2567
Practice Address - Street 1:11154 HURON ST
Practice Address - Street 2:SUITE 211
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-2328
Practice Address - Country:US
Practice Address - Phone:303-888-2120
Practice Address - Fax:303-255-2567
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1617103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07016173Medicaid
CO07016173Medicaid
COC451778Medicare PIN