Provider Demographics
NPI:1073658159
Name:HYATT, DONNA J (LCSW)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:J
Last Name:HYATT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6117 KISSENGEN SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5136
Mailing Address - Country:US
Mailing Address - Phone:904-524-2012
Mailing Address - Fax:
Practice Address - Street 1:10175 FORTUNE PKWY UNIT 303
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6749
Practice Address - Country:US
Practice Address - Phone:904-524-0826
Practice Address - Fax:904-880-1856
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW92181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical