Provider Demographics
NPI:1790582260
Name:DONNELLY, MORGAN MARY
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:MARY
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11123 OAK LN APT 5216
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48111-4306
Mailing Address - Country:US
Mailing Address - Phone:386-216-9326
Mailing Address - Fax:
Practice Address - Street 1:11123 OAK LN APT 5216
Practice Address - Street 2:
Practice Address - City:VAN BUREN TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48111-4306
Practice Address - Country:US
Practice Address - Phone:386-216-9326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851117086104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker