Provider Demographics
NPI:1467296798
Name:DONNA AMUNDSON LCSW
Entity type:Organization
Organization Name:DONNA AMUNDSON LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:AMUNDSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:732-893-8107
Mailing Address - Street 1:190 MAIN STREET SUITE101
Mailing Address - Street 2:PO BOX 430
Mailing Address - City:GLADSTONE
Mailing Address - State:NJ
Mailing Address - Zip Code:07934
Mailing Address - Country:US
Mailing Address - Phone:908-227-2009
Mailing Address - Fax:
Practice Address - Street 1:190 MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:NJ
Practice Address - Zip Code:07934-2064
Practice Address - Country:US
Practice Address - Phone:908-625-1820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health