Provider Demographics
NPI:1982741385
Name:O'CONNELL-GILMORE, DONNA (LICSW)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:O'CONNELL-GILMORE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 299
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORLEANS
Mailing Address - State:MA
Mailing Address - Zip Code:02662-0299
Mailing Address - Country:US
Mailing Address - Phone:508-255-1420
Mailing Address - Fax:508-255-9929
Practice Address - Street 1:527 S ORLEANS RD
Practice Address - Street 2:
Practice Address - City:SOUTH ORLEANS
Practice Address - State:MA
Practice Address - Zip Code:02662-0299
Practice Address - Country:US
Practice Address - Phone:508-255-1420
Practice Address - Fax:508-255-9929
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101991101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health