MEDICARE: FRANCES MARY DONOVAN C.S.W.

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	1041C0700X	Clinical Social Worker	036599	NY

General Provider Information

NPI Number	:	1437381183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRANCES MARY DONOVAN C.S.W.

Provider Business Mailing Address
First Line	:	9 N MAIN ST
Second Line	:
City	:	EAST HAMPTON
State	:	NY
Zip	:	11937-2632
Country	:	US
Telephone Number	:	631-329-1314
Fax Number	:	631-324-9247

Provider Business Practice Location Address
First Line	:	9 N MAIN ST
Second Line	:
City	:	EAST HAMPTON
State	:	NY
Zip	:	11937-2632
Country	:	US
Telephone Number	:	631-329-1314
Fax Number	:	631-324-9247

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

Provider Enumeration Date	:	08/13/2009
Last Update Date	:	08/13/2009

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