Healthcare Provider Details

I. General information

NPI: 1801750997
Provider Name (Legal Business Name): AIDAN LAFOUNTAINE DONOGHUE LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 BOYLAN LN N
BLUE POINT NY
11715-1806
US

IV. Provider business mailing address

150 BOYLAN LN N
BLUE POINT NY
11715-1806
US

V. Phone/Fax

Practice location:
  • Phone: 516-350-3902
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number129659
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: