Provider Demographics
NPI:1265512040
Name:PODOREFSKY, DONNA L (PHD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:L
Last Name:PODOREFSKY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 CENTRE ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NEWTON CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2454
Mailing Address - Country:US
Mailing Address - Phone:617-965-7034
Mailing Address - Fax:617-965-7979
Practice Address - Street 1:1400 CENTRE ST
Practice Address - Street 2:SUITE 105
Practice Address - City:NEWTON CENTER
Practice Address - State:MA
Practice Address - Zip Code:02459-2454
Practice Address - Country:US
Practice Address - Phone:617-965-7034
Practice Address - Fax:617-965-7979
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6940103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA8415-01OtherPACIFICARE BEHAVIORAL HEA
MAW05509OtherBLUE CROSS BLUE SHIELD
MA275862OtherVALUE OPTIONS
MA275862OtherVALUE OPTIONS