Provider Demographics
NPI:1336320530
Name:DONOVAN, PATRICK J (NYS LMHC/CASAC)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:J
Last Name:DONOVAN
Suffix:
Gender:M
Credentials:NYS LMHC/CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 WISNER RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-3436
Mailing Address - Country:US
Mailing Address - Phone:845-986-1881
Mailing Address - Fax:845-986-1888
Practice Address - Street 1:7 WISNER RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-3436
Practice Address - Country:US
Practice Address - Phone:845-986-1881
Practice Address - Fax:845-986-1888
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10890101YA0400X
NY000358101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10890OtherNYS CASAC
NY000358OtherNYS LMHC