Healthcare Provider Details

I. General information

NPI: 1700996428
Provider Name (Legal Business Name): BEVERLY SUE DONOVAN PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 TALL GRASS CIR APT 102
STOW OH
44224-6905
US

IV. Provider business mailing address

1017 TALL GRASS CIR APT 102
STOW OH
44224-6905
US

V. Phone/Fax

Practice location:
  • Phone: 440-526-3030
  • Fax: 440-838-6085
Mailing address:
  • Phone: 440-526-3030
  • Fax: 440-838-6085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4976
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4976
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: