Provider Demographics
NPI:1952320566
Name:DONOVAN, TIMOTHY C (MSW LCSW-R ACSW DCSW)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:C
Last Name:DONOVAN
Suffix:
Gender:M
Credentials:MSW LCSW-R ACSW DCSW
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 815
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-0815
Mailing Address - Country:US
Mailing Address - Phone:607-432-1607
Mailing Address - Fax:607-432-1607
Practice Address - Street 1:75 CHESTNUT ST
Practice Address - Street 2:FIRST FLOOR, SUITE D
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2422
Practice Address - Country:US
Practice Address - Phone:607-432-1607
Practice Address - Fax:607-432-1607
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR0329201041C0700X
IN34004228A1041C0700X
OHI86801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY52523BMedicare ID - Type UnspecifiedUPSTATE MEDICARE DIVISION
NYR55938Medicare UPIN