MEDICARE: BETH B DONOVAN LPCMH

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1366716938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH B DONOVAN LPCMH

Provider Business Mailing Address
First Line	:	410 FOULK RD STE 102
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19803-3835
Country	:	US
Telephone Number	:	302-530-9520
Fax Number	:

Provider Business Practice Location Address
First Line	:	1053 COUNTRY CLUB RD
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19382-8060
Country	:	US
Telephone Number	:	302-530-9520
Fax Number	:	610-279-7156

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

Provider Enumeration Date	:	02/29/2012
Last Update Date	:	12/20/2024

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