MEDICARE: MS. PATRICIA MARY DONOVAN LCSW, CASAC

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	R042462-1	NY

General Provider Information

NPI Number	:	1235383332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICIA MARY DONOVAN LCSW, CASAC

Provider Business Mailing Address
First Line	:	439 W WALNUT ST
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-3132
Country	:	US
Telephone Number	:	917-270-3311
Fax Number	:

Provider Business Practice Location Address
First Line	:	439 W WALNUT ST
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-3132
Country	:	US
Telephone Number	:	917-270-3311
Fax Number	:

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

Provider Enumeration Date	:	11/17/2008
Last Update Date	:	11/17/2008

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