Provider Demographics
NPI:1841412608
Name:DONOFRIO, JOHN (MSW LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:DONOFRIO
Suffix:
Gender:M
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BOND ST
Mailing Address - Street 2:212
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-2002
Mailing Address - Country:US
Mailing Address - Phone:516-773-3461
Mailing Address - Fax:516-773-3689
Practice Address - Street 1:15 BOND ST
Practice Address - Street 2:212
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2002
Practice Address - Country:US
Practice Address - Phone:516-773-3461
Practice Address - Fax:516-773-3689
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0260941104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
N03511Medicare ID - Type Unspecified