Provider Demographics
NPI:1407886237
Name:DONOVAN, ANN SHARON (LCSW)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:SHARON
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2378 PRINCE WAY
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-2701
Mailing Address - Country:US
Mailing Address - Phone:760-726-5243
Mailing Address - Fax:
Practice Address - Street 1:2378 PRINCE WAY
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-2701
Practice Address - Country:US
Practice Address - Phone:760-726-5243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS139081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR37509Medicare UPIN
CASW13908Medicare ID - Type Unspecified