Provider Demographics
NPI:1669217162
Name:ISRAEL, DONNA GREEN (MS)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:GREEN
Last Name:ISRAEL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10521 LAKE WILLIAMS DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-2615
Mailing Address - Country:US
Mailing Address - Phone:727-271-1767
Mailing Address - Fax:
Practice Address - Street 1:6014 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-2505
Practice Address - Country:US
Practice Address - Phone:727-271-1767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL26003101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health