Provider Demographics
NPI:1730102187
Name:RETHEMEYER, DONNA LEE (LCSW)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:LEE
Last Name:RETHEMEYER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 HICKORY HILL PL
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-4858
Mailing Address - Country:US
Mailing Address - Phone:386-453-8983
Mailing Address - Fax:
Practice Address - Street 1:595 W GRANADA BLVD
Practice Address - Street 2:SUITE 2E
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5190
Practice Address - Country:US
Practice Address - Phone:386-672-4222
Practice Address - Fax:386-672-8855
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW21051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ3774Medicare ID - Type Unspecified