MEDICARE: MS. DONNA O'HEARON 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	046117	NY

General Provider Information

NPI Number	:	1366143158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DONNA O'HEARON LMSW

Provider Business Mailing Address
First Line	:	859 CONNETQUOT AVE STE 10
Second Line	:
City	:	ISLIP TERRACE
State	:	NY
Zip	:	11752-1400
Country	:	US
Telephone Number	:	631-277-8300
Fax Number	:

Provider Business Practice Location Address
First Line	:	859 CONNETQUOT AVE STE 10
Second Line	:
City	:	ISLIP TERRACE
State	:	NY
Zip	:	11752-1400
Country	:	US
Telephone Number	:	631-277-8300
Fax Number	:

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

Provider Enumeration Date	:	03/17/2023
Last Update Date	:	03/17/2023

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