Healthcare Provider Details

I. General information

NPI: 1477488328
Provider Name (Legal Business Name): NEIL ARTHUR DONAH LADC I
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 DERRYFIELD AVE
SPRINGFIELD MA
01118-1320
US

IV. Provider business mailing address

19 DERRYFIELD AVE
SPRINGFIELD MA
01118-1320
US

V. Phone/Fax

Practice location:
  • Phone: 413-519-3104
  • Fax:
Mailing address:
  • Phone: 413-519-3104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number23205
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: