Healthcare Provider Details

I. General information

NPI: 1497204127
Provider Name (Legal Business Name): PAUL DONOVAN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2016
Last Update Date: 09/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2446 WHITNEY AVE #2
HAMDEN CT
06518-3233
US

IV. Provider business mailing address

2446 WHITNEY AVE #2
HAMDEN CT
06518-3233
US

V. Phone/Fax

Practice location:
  • Phone: 203-298-9005
  • Fax: 203-535-0023
Mailing address:
  • Phone: 203-298-9005
  • Fax: 203-535-0023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number009562
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: