Healthcare Provider Details

I. General information

NPI: 1932297686
Provider Name (Legal Business Name): STEPHEN P DONAHUE M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 CHESTER PIKE
PROSPECT PARK PA
19076-2322
US

IV. Provider business mailing address

2719 HOLLYWOOD BLVD STE 5469
HOLLYWOOD FL
33020-4821
US

V. Phone/Fax

Practice location:
  • Phone: 973-264-0023
  • Fax: 973-264-0022
Mailing address:
  • Phone: 973-264-0023
  • Fax: 973-264-0022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS008101L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberPS008101L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: