Provider Demographics
NPI:1285751669
Name:DONOVAN, DEBORAH SARGENT (RD LDN LMHC)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:SARGENT
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:RD LDN LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 INDIANA COURT
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02464-1312
Mailing Address - Country:US
Mailing Address - Phone:617-244-6753
Mailing Address - Fax:
Practice Address - Street 1:2014 WASHINGTON STREET
Practice Address - Street 2:NEWTON WELLESLEY HOSPITAL
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462-1607
Practice Address - Country:US
Practice Address - Phone:617-243-5212
Practice Address - Fax:617-243-6798
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5135101YM0800X
MA207133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMT0750Medicare ID - Type Unspecified