Provider Demographics
NPI:1700996428
Name:DONOVAN, BEVERLY SUE (PHD)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:SUE
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 TALL GRASS CIR APT 102
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-6905
Mailing Address - Country:US
Mailing Address - Phone:440-526-3030
Mailing Address - Fax:440-838-6085
Practice Address - Street 1:1017 TALL GRASS CIR APT 102
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-6905
Practice Address - Country:US
Practice Address - Phone:440-526-3030
Practice Address - Fax:440-838-6085
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4976103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical