Healthcare Provider Details

I. General information

NPI: 1225443708
Provider Name (Legal Business Name): ASHLEY DONOVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 10/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BRADLEY RD 905
WOODBRIDGE CT
06525-2285
US

IV. Provider business mailing address

1 BRADLEY RD 905
WOODBRIDGE CT
06525-2285
US

V. Phone/Fax

Practice location:
  • Phone: 203-298-9005
  • Fax:
Mailing address:
  • Phone: 203-298-9005
  • Fax: 203-298-9006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8662
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: