Provider Demographics
NPI:1255691333
Name:LOVEJOY, DONALD WILLIAM (CDP)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:WILLIAM
Last Name:LOVEJOY
Suffix:
Gender:M
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3671
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-0671
Mailing Address - Country:US
Mailing Address - Phone:401-474-9650
Mailing Address - Fax:
Practice Address - Street 1:1076 PARK AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-3133
Practice Address - Country:US
Practice Address - Phone:401-474-9650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICDP00515104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
RICDP00515OtherCDP00515