Provider Demographics
NPI:1194278085
Name:DONATO, IMELDA
Entity type:Individual
Prefix:MS
First Name:IMELDA
Middle Name:
Last Name:DONATO
Suffix:
Gender:
Credentials:
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 693133
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95269-3133
Mailing Address - Country:US
Mailing Address - Phone:209-440-0143
Mailing Address - Fax:
Practice Address - Street 1:3108 W HAMMER LN STE B
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-2752
Practice Address - Country:US
Practice Address - Phone:209-440-0143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-27
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10174101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional