Provider Demographics
NPI:1245800549
Name:O'DONOVAN, MARY THERESA (CERTIFIED RECOVERY)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:THERESA
Last Name:O'DONOVAN
Suffix:
Gender:F
Credentials:CERTIFIED RECOVERY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 S. ORANGE ST.
Mailing Address - Street 2:STE 5
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063
Mailing Address - Country:US
Mailing Address - Phone:855-687-2410
Mailing Address - Fax:
Practice Address - Street 1:206 S. ORANGE ST.
Practice Address - Street 2:STE 5
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063
Practice Address - Country:US
Practice Address - Phone:855-687-2410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist