Provider Demographics
NPI:1720227366
Name:GERMAIN, DONNA F (CCC,SLP,LCSW)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:F
Last Name:GERMAIN
Suffix:
Gender:F
Credentials:CCC,SLP,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 W 110TH ST
Mailing Address - Street 2:APT 10A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-2637
Mailing Address - Country:US
Mailing Address - Phone:212-767-1431
Mailing Address - Fax:
Practice Address - Street 1:330 W 58TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1827
Practice Address - Country:US
Practice Address - Phone:212-767-1431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069975-11041C0700X
NY007083235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist