Provider Demographics
NPI:1104681030
Name:DONOVAN, LISA MARIE (MS,CCLS,RWWP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:MS,CCLS,RWWP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:869 MAIN ST STE 6B
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-2985
Mailing Address - Country:US
Mailing Address - Phone:781-269-9788
Mailing Address - Fax:781-327-2703
Practice Address - Street 1:603 NEPONSET ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-1981
Practice Address - Country:US
Practice Address - Phone:781-255-1817
Practice Address - Fax:781-762-8542
Is Sole Proprietor?:No
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health