Provider Demographics
NPI:1295871788
Name:ENGLISH, DONNA DETRIO (PHD)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:DETRIO
Last Name:ENGLISH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:DONNA
Other - Middle Name:MAE
Other - Last Name:DETRIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:58 MAGNA DRIVE
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:NJ
Mailing Address - Zip Code:07933-1417
Mailing Address - Country:US
Mailing Address - Phone:908-604-4938
Mailing Address - Fax:
Practice Address - Street 1:27 MOUNTAIN BLVD
Practice Address - Street 2:SUITE 10
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-5605
Practice Address - Country:US
Practice Address - Phone:908-279-7950
Practice Address - Fax:908-279-7948
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00276300103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
581684078OtherTAX ID
129099000OtherMAGELLAN
74986OtherCIGNA
S03269Medicare UPIN
EN658836Medicare ID - Type Unspecified