Provider Demographics
NPI:1265525521
Name:DONNELLY, PAUL ALBERT (EDD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ALBERT
Last Name:DONNELLY
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:MA
Mailing Address - Zip Code:02726-3205
Mailing Address - Country:US
Mailing Address - Phone:508-672-1851
Mailing Address - Fax:
Practice Address - Street 1:345 HANOVER ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-5421
Practice Address - Country:US
Practice Address - Phone:508-679-6950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3041103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist