Provider Demographics
NPI:1386655819
Name:DONOVAN, HEIDI C (PHD)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:C
Last Name:DONOVAN
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 1:5632 WHISPERING WOODS DR
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-8327
Mailing Address - Country:US
Mailing Address - Phone:850-995-8018
Mailing Address - Fax:850-492-7667
Practice Address - Street 1:5632 WHISPERING WOODS DR
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-8327
Practice Address - Country:US
Practice Address - Phone:850-995-8018
Practice Address - Fax:850-492-7667
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6842103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74028OtherBLUE
FL74028Medicare ID - Type Unspecified