Provider Demographics
NPI:1477577781
Name:DONAHUE, MELISSA L.
Entity Type:Individual
Prefix:MISS
First Name:MELISSA L.
Middle Name:
Last Name:DONAHUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:589 FRANKLIN TPKE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-1989
Mailing Address - Country:US
Mailing Address - Phone:201-240-9788
Mailing Address - Fax:201-977-2571
Practice Address - Street 1:589 FRANKLIN TPKE
Practice Address - Street 2:SUITE 7
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-1989
Practice Address - Country:US
Practice Address - Phone:201-240-9788
Practice Address - Fax:201-977-2571
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052808001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical