Provider Demographics
NPI:1417652397
Name:DONTONVILLE, OLIVIA LAUREN (M ED, LBS)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:LAUREN
Last Name:DONTONVILLE
Suffix:
Gender:F
Credentials:M ED, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 WINTERTHUR LN
Mailing Address - Street 2:
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951-5234
Mailing Address - Country:US
Mailing Address - Phone:267-424-3809
Mailing Address - Fax:
Practice Address - Street 1:1125 BERKSHIRE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1222
Practice Address - Country:US
Practice Address - Phone:856-346-0005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH006325103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst