Provider Demographics
NPI:1679983076
Name:DONOVAN, RICHARD JR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:DONOVAN
Suffix:JR
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:PO BOX 14
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46703-0098
Mailing Address - Country:US
Mailing Address - Phone:260-665-2972
Mailing Address - Fax:260-665-3026
Practice Address - Street 1:603 N WAYNE ST
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-1081
Practice Address - Country:US
Practice Address - Phone:260-233-0780
Practice Address - Fax:260-665-3026
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-07
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001008A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical