Provider Demographics
NPI:1750599957
Name:DONOVAN, ROBERT DAVOL (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DAVOL
Last Name:DONOVAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 WRIGHT PL
Mailing Address - Street 2:
Mailing Address - City:SOUTH HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01075-1517
Mailing Address - Country:US
Mailing Address - Phone:413-532-5379
Mailing Address - Fax:
Practice Address - Street 1:7 WRIGHT PL
Practice Address - Street 2:
Practice Address - City:SOUTH HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01075-1517
Practice Address - Country:US
Practice Address - Phone:413-532-5379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6232103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW05051OtherBLUE CROSS BLUE SHIELD