Healthcare Provider Details

I. General information

NPI: 1942572284
Provider Name (Legal Business Name): PATRICIA DONNAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2012
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 WHITEHALL RD
ALBANY NY
12209-1447
US

IV. Provider business mailing address

39 FLEETWOOD AVE
ALBANY NY
12208-2311
US

V. Phone/Fax

Practice location:
  • Phone: 518-475-6832
  • Fax:
Mailing address:
  • Phone: 518-225-8677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number074541
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: