Provider Demographics
NPI:1497204127
Name:DONOVAN, PAUL (LCSW)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:DONOVAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2446 WHITNEY AVE
Mailing Address - Street 2:#2
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3233
Mailing Address - Country:US
Mailing Address - Phone:203-298-9005
Mailing Address - Fax:203-535-0023
Practice Address - Street 1:2446 WHITNEY AVE
Practice Address - Street 2:#2
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3233
Practice Address - Country:US
Practice Address - Phone:203-298-9005
Practice Address - Fax:203-535-0023
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0095621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT009562OtherLICENSE - STATE OF CT