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NPI Code Detail

MEDICARE: ELAINE DONOVAN

MEDICARE:   ELAINE  DONOVAN
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
1101YA0400XAddiction (Substance Use Disorder) Counselor206416MA
2101YA0400XAddiction (Substance Use Disorder) Counselor853MA

General Provider Information

NPI Number : 1457672875
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELAINE DONOVAN
Provider Business Mailing Address
First Line : 125 N ELM ST
Second Line :
City : WESTFIELD
State : MA
Zip : 01085-1643
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 175 CRESCENT AVE
Second Line :
City : CHELSEA
State : MA
Zip : 02150-3009
Country : US
Telephone Number : 617-889-8779
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2010
Last Update Date : 06/21/2010

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Directions to “ ELAINE DONOVAN ” Practice Location

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