Provider Demographics
NPI:1154487379
Name:ORTOLANI-HOMBERG, DONNA ANN (MA)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:ANN
Last Name:ORTOLANI-HOMBERG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20 GREENWOOD LAKE TPKE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RINGWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07456-1500
Mailing Address - Country:US
Mailing Address - Phone:973-839-1879
Mailing Address - Fax:973-962-4064
Practice Address - Street 1:20 GREENWOOD LAKE TPKE
Practice Address - Street 2:SUITE 102
Practice Address - City:RINGWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07456-1500
Practice Address - Country:US
Practice Address - Phone:973-839-1879
Practice Address - Fax:973-962-4064
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00145800101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional