Healthcare Provider Details

I. General information

NPI: 1497974331
Provider Name (Legal Business Name): MICHAEL J. DONAHUE ED.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 03/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 WALNUT ST
SHREWSBURY MA
01545-3366
US

IV. Provider business mailing address

66 WALNUT ST
SHREWSBURY MA
01545-3366
US

V. Phone/Fax

Practice location:
  • Phone: 508-845-5411
  • Fax: 508-842-2314
Mailing address:
  • Phone: 508-845-5411
  • Fax: 508-842-2314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2273
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2273
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number2273
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: