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NPI Code Detail

MEDICARE: JENAVIEVE DONNELLY LCSW

MEDICARE: JENAVIEVE DONNELLY LCSW
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
11041C0700XClinical Social Worker24561CA

General Provider Information

NPI Number : 1093032591
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENAVIEVE DONNELLY LCSW
Provider Business Mailing Address
First Line : 422 WINDWARD DR
Second Line :
City : MURPHY
State : TX
Zip : 75094-5337
Country : US
Telephone Number : 619-249-1173
Fax Number :
Provider Business Practice Location Address
First Line : 4929 WILSHIRE BLVD STE 500
Second Line :
City : LOS ANGELES
State : CA
Zip : 90010-3820
Country : US
Telephone Number : 800-275-3243
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2010
Last Update Date : 08/26/2021

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Directions to “ JENAVIEVE DONNELLY LCSW” Practice Location

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