Provider Demographics
NPI:1518364264
Name:DONLAN, MATTHEW MARTIN (DBH, MBA)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:MARTIN
Last Name:DONLAN
Suffix:
Gender:M
Credentials:DBH, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 TARA TER
Mailing Address - Street 2:
Mailing Address - City:BOURNE
Mailing Address - State:MA
Mailing Address - Zip Code:02532-3883
Mailing Address - Country:US
Mailing Address - Phone:617-877-9594
Mailing Address - Fax:
Practice Address - Street 1:61 TARA TER
Practice Address - Street 2:
Practice Address - City:BOURNE
Practice Address - State:MA
Practice Address - Zip Code:02532-3883
Practice Address - Country:US
Practice Address - Phone:617-877-9594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-24
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13071101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor