Provider Demographics
NPI:1427203926
Name:DONOVAN, DEBORAH (MA)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MHREEC 241 NORTH RD
Mailing Address - Street 2:SUITE 400A
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601
Mailing Address - Country:US
Mailing Address - Phone:845-431-8803
Mailing Address - Fax:845-483-5688
Practice Address - Street 1:15 HASTINGS DR
Practice Address - Street 2:
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508-2056
Practice Address - Country:US
Practice Address - Phone:845-838-4440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-25
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY$$$$$$$$$OtherTEACHER OF SPEECH AND HEARING HANDICAPPED CERTIFICATION