Healthcare Provider Details

I. General information

NPI: 1588909733
Provider Name (Legal Business Name): ELAINE M DONAGHUE LCSW, ACSW, RN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2012
Last Update Date: 11/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 E ATLANTIC AVE SUITE B4
DELRAY BEACH FL
33483-5360
US

IV. Provider business mailing address

777 E ATLANTIC AVE SUITE B4
DELRAY BEACH FL
33483-5360
US

V. Phone/Fax

Practice location:
  • Phone: 561-279-2727
  • Fax: 561-732-9751
Mailing address:
  • Phone: 561-279-2727
  • Fax: 561-732-9751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberSW 4422
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberSW 4422
License Number StateFL

VIII. Authorized Official

Name: MS. ELAINE M DONAGHUE
Title or Position: PSYCHOTHERAPIST
Credential: LCSW, ACSW, RN, LLC
Phone: 561-279-2727