MEDICARE: MEGHAN DONOVAN LMSW

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	104100000X	Social Worker	095811	NY

General Provider Information

NPI Number	:	1215558911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGHAN DONOVAN LMSW

Provider Business Mailing Address
First Line	:	10802 72ND AVE
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-2463
Country	:	US
Telephone Number	:	929-322-4611
Fax Number	:

Provider Business Practice Location Address
First Line	:	10802 72ND AVE
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-2463
Country	:	US
Telephone Number	:	929-322-4611
Fax Number	:

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

Provider Enumeration Date	:	05/04/2020
Last Update Date	:	08/26/2020

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