Provider Demographics
NPI:1811412406
Name:DONOVAN, ERIN SUSAN (MSW, LISW)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:SUSAN
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2543 SPINDLEHILL DR APT 5
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-1030
Mailing Address - Country:US
Mailing Address - Phone:614-286-8201
Mailing Address - Fax:
Practice Address - Street 1:2100 PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45015-1133
Practice Address - Country:US
Practice Address - Phone:513-867-4750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-04
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.22041731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0270959Medicaid