Healthcare Provider Details

I. General information

NPI: 1851745491
Provider Name (Legal Business Name): JANINE MARIE DONOVAN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 04/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 FORDHAM RD
WEST BABYLON NY
11704-5803
US

IV. Provider business mailing address

30 DR REED BLVD
AMITYVILLE NY
11701-1207
US

V. Phone/Fax

Practice location:
  • Phone: 631-321-7011
  • Fax:
Mailing address:
  • Phone: 516-642-7872
  • Fax: 631-957-3278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number004744-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: