Provider Demographics
NPI:1497974331
Name:DONAHUE, MICHAEL J (EDD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:DONAHUE
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-3366
Mailing Address - Country:US
Mailing Address - Phone:508-845-5411
Mailing Address - Fax:508-842-2314
Practice Address - Street 1:66 WALNUT ST
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-3366
Practice Address - Country:US
Practice Address - Phone:508-845-5411
Practice Address - Fax:508-842-2314
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2273103T00000X, 103TC1900X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth