Provider Demographics
NPI:1215558911
Name:DONOVAN, MEGHAN (LMSW)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10802 72ND AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2463
Mailing Address - Country:US
Mailing Address - Phone:929-322-4611
Mailing Address - Fax:
Practice Address - Street 1:10802 72ND AVE
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2463
Practice Address - Country:US
Practice Address - Phone:929-322-4611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-04
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY095811104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker