Provider Demographics
NPI:1972031185
Name:DONOVAN, ANDREA MERRIAM (MSW)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:MERRIAM
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 S MAIN ST STE 5
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-4309
Mailing Address - Country:US
Mailing Address - Phone:435-586-4966
Mailing Address - Fax:435-586-4939
Practice Address - Street 1:965 S MAIN ST STE 5
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-4309
Practice Address - Country:US
Practice Address - Phone:435-586-4966
Practice Address - Fax:435-586-4939
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8510156-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical