Provider Demographics
NPI:1245388487
Name:DONNELLAN, GERARD JOSEPH (PHD)
Entity Type:Individual
Prefix:DR
First Name:GERARD
Middle Name:JOSEPH
Last Name:DONNELLAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MINOLA RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-5512
Mailing Address - Country:US
Mailing Address - Phone:781-863-5354
Mailing Address - Fax:781-861-1639
Practice Address - Street 1:8 MINOLA RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-5512
Practice Address - Country:US
Practice Address - Phone:781-863-5354
Practice Address - Fax:781-861-1639
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2276103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical