Provider Demographics
NPI:1972205706
Name:VANDERPOEL, DONNA (LMSW)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:VANDERPOEL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:ORSINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:M ED
Mailing Address - Street 1:475 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06605-1700
Mailing Address - Country:US
Mailing Address - Phone:203-368-4291
Mailing Address - Fax:
Practice Address - Street 1:LIFEBRIDGE COMMUNITY SERVICES
Practice Address - Street 2:475 CLINTON AVE
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606
Practice Address - Country:US
Practice Address - Phone:203-368-4291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT69171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical