Healthcare Provider Details

I. General information

NPI: 1508134875
Provider Name (Legal Business Name): JILL M DONELAN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILL M DONELAN PSY.D.

II. Dates (important events)

Enumeration Date: 12/01/2011
Last Update Date: 06/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 WETHERSFIELD AVE THE VILLAGE FOR FAMILIES AND CHILDREN
HARTFORD CT
06114
US

IV. Provider business mailing address

150 LOWER WESTFIELD RD
HOLYOKE MA
01040-2890
US

V. Phone/Fax

Practice location:
  • Phone: 860-236-4511
  • Fax: 860-231-8449
Mailing address:
  • Phone: 413-322-4984
  • Fax: 133-224-4992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number10049-PY-PR
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: