Provider Demographics
NPI:1508282047
Name:DONELLI, JACQUELINE (LMHC)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:DONELLI
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W 43RD ST
Mailing Address - Street 2:#6-O
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-6302
Mailing Address - Country:US
Mailing Address - Phone:646-410-1188
Mailing Address - Fax:347-343-2907
Practice Address - Street 1:400 W 43RD ST
Practice Address - Street 2:#6-O
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-6302
Practice Address - Country:US
Practice Address - Phone:646-410-1188
Practice Address - Fax:347-343-2907
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-07
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health