Healthcare Provider Details

I. General information

NPI: 1093778862
Provider Name (Legal Business Name): JOANNE DONATO-POPKO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOANNE DONATO LCSW

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 N BLAKELY ST
DUNMORE PA
18512-1943
US

IV. Provider business mailing address

1251 WYOMING AVE
EXETER PA
18643-1434
US

V. Phone/Fax

Practice location:
  • Phone: 570-342-8434
  • Fax: 570-342-7446
Mailing address:
  • Phone: 570-342-8434
  • Fax: 570-299-2521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW007364L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier240818341001
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerMAGELLAN
# 2
Identifier4610464
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAETNA
# 3
IdentifierIP158388
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerGREEN SPRING

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: