Provider Demographics
NPI:1275625550
Name:DONNELLY, JAMES PATRICK (DSW)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:PATRICK
Last Name:DONNELLY
Suffix:
Gender:M
Credentials:DSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 E 67TH ST
Mailing Address - Street 2:18D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5914
Mailing Address - Country:US
Mailing Address - Phone:212-879-7086
Mailing Address - Fax:212-744-1407
Practice Address - Street 1:160 E 89TH ST
Practice Address - Street 2:1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-2305
Practice Address - Country:US
Practice Address - Phone:212-879-7086
Practice Address - Fax:212-744-1407
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYLCSW R0140811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
N20442Medicare ID - Type Unspecified