Provider Demographics
NPI:1649304551
Name:DONOVAN, WILLIAM T (PHD, LMHC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:T
Last Name:DONOVAN
Suffix:
Gender:M
Credentials:PHD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-1303
Mailing Address - Country:US
Mailing Address - Phone:631-521-7305
Mailing Address - Fax:
Practice Address - Street 1:9 MOTT PL
Practice Address - Street 2:
Practice Address - City:EASTPORT
Practice Address - State:NY
Practice Address - Zip Code:11941-1124
Practice Address - Country:US
Practice Address - Phone:631-325-1030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001840101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health