Provider Demographics
NPI:1689056913
Name:DONOVAN, MICHELE M (PLMSW)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:M
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:PLMSW
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:M
Other - Last Name:DONOVAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:2001 ROLLING RIDGE DR SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-5357
Mailing Address - Country:US
Mailing Address - Phone:505-859-6378
Mailing Address - Fax:
Practice Address - Street 1:4004 CARLISLE BLVD NE STE A2
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4566
Practice Address - Country:US
Practice Address - Phone:505-859-6378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-23
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-106481041C0700X
NMX-09166104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical