Provider Demographics
NPI:1922754183
Name:FONTANA, DONNA M (LSW)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:M
Last Name:FONTANA
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 352
Mailing Address - Street 2:
Mailing Address - City:BAY HEAD
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-0352
Mailing Address - Country:US
Mailing Address - Phone:908-415-8776
Mailing Address - Fax:
Practice Address - Street 1:2290 W COUNTY LINE RD STE 105
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-2267
Practice Address - Country:US
Practice Address - Phone:908-415-8776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-26
Last Update Date:2022-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06753700104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker