Provider Demographics
NPI:1316183502
Name:DONOVAN, WYETTE W (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:WYETTE
Middle Name:W
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 N 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-5611
Mailing Address - Country:US
Mailing Address - Phone:850-470-9300
Mailing Address - Fax:850-470-9500
Practice Address - Street 1:1521 N 14TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-5611
Practice Address - Country:US
Practice Address - Phone:850-470-9300
Practice Address - Fax:850-470-9500
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW18901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical