Provider Demographics
NPI:1861509853
Name:DONOHUE, VIRGINIA M (LCSWR)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:M
Last Name:DONOHUE
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 WARREN ST
Mailing Address - Street 2:SUITE 215
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4565
Mailing Address - Country:US
Mailing Address - Phone:518-741-6111
Mailing Address - Fax:518-741-0142
Practice Address - Street 1:5 WARREN ST
Practice Address - Street 2:SUITE 215
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4565
Practice Address - Country:US
Practice Address - Phone:518-741-6111
Practice Address - Fax:518-741-0142
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR051389-11041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01742718Medicaid
NY01742718Medicaid
NYJ300079446Medicare PIN