Provider Demographics
NPI:1124151196
Name:DONOHUE, JESSICA JAMES (LMSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:JAMES
Last Name:DONOHUE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3304 HARDISTY AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-3009
Mailing Address - Country:US
Mailing Address - Phone:713-828-1420
Mailing Address - Fax:
Practice Address - Street 1:3740 GLENWAY AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45205-1354
Practice Address - Country:US
Practice Address - Phone:513-345-8555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40858104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker