MEDICARE: MS. ELIZABETH P DONOVAN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	R035179-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R035179-1	OTHER	NY	NYS LICENSE

General Provider Information

NPI Number	:	1003927039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH P DONOVAN LCSW

Provider Business Mailing Address
First Line	:	113 HOLLAND AVE
Second Line	:	STRATTON VA MEDICAL CENTER
City	:	ALBANY
State	:	NY
Zip	:	12208-3410
Country	:	US
Telephone Number	:	518-626-5347
Fax Number	:

Provider Business Practice Location Address
First Line	:	7 JOANNE CT
Second Line	:
City	:	WEST SAND LAKE
State	:	NY
Zip	:	12196-9612
Country	:	US
Telephone Number	:	518-577-3891
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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