=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841343498
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMY E. DONOGHUE LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2007
-----------------------------------------------------
Last Update Date | 06/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 150 MORRISTOWN RD STE 108
-----------------------------------------------------
City | BERNARDSVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07924-2626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-664-6466
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 83 MAIDEN LN
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10038-4812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-484-8940
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 075085
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 44SC05831700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------