Provider Demographics
NPI:1760537146
Name:MORGAN, DONNA DONEGAN (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:DONEGAN
Last Name:MORGAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 DEVON RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-1649
Mailing Address - Country:US
Mailing Address - Phone:617-965-2280
Mailing Address - Fax:
Practice Address - Street 1:45 DEVON RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-1649
Practice Address - Country:US
Practice Address - Phone:617-965-2280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1014871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO1429Medicare UPIN