Provider Demographics
NPI:1669920534
Name:DONOFRIO, JUSTIN (LCSW)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:
Last Name:DONOFRIO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 W 55TH ST APT 4H
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-4516
Mailing Address - Country:US
Mailing Address - Phone:347-256-3996
Mailing Address - Fax:
Practice Address - Street 1:928 BROADWAY, STE 400
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-3055
Practice Address - Country:US
Practice Address - Phone:646-820-0603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-20
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY084439-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical