Provider Demographics
NPI:1275059743
Name:DONEGAN, MARYANN (LCSW 13579)
Entity Type:Individual
Prefix:
First Name:MARYANN
Middle Name:
Last Name:DONEGAN
Suffix:
Gender:F
Credentials:LCSW 13579
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9015 MURRAY AVE # 100
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-3617
Mailing Address - Country:US
Mailing Address - Phone:408-842-7138
Mailing Address - Fax:
Practice Address - Street 1:9015 MURRAY AVE
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-3617
Practice Address - Country:US
Practice Address - Phone:408-842-7138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA135791041C0700X
CALCSW135791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical