Provider Demographics
NPI:1306308960
Name:DONAHUE, JUDITH ELLEN (BA)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ELLEN
Last Name:DONAHUE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 E MOUNTAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-1400
Mailing Address - Country:US
Mailing Address - Phone:508-755-0556
Mailing Address - Fax:508-853-1308
Practice Address - Street 1:29 E MOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-1400
Practice Address - Country:US
Practice Address - Phone:508-755-0556
Practice Address - Fax:508-853-1308
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-03
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor