Healthcare Provider Details

I. General information

NPI: 1467808972
Provider Name (Legal Business Name): JOSEPH DONEGAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2016
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4163 NW FEDERAL HWY STE 22CD
JENSEN BEACH FL
34957-3623
US

IV. Provider business mailing address

4620 N STATE ROAD 7 STE 300
LAUDERDALE LAKES FL
33319-5867
US

V. Phone/Fax

Practice location:
  • Phone: 772-773-1975
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: