Provider Demographics
NPI:1427316108
Name:DEPOLA, DONNA MAE (CASAC, CPP)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:MAE
Last Name:DEPOLA
Suffix:
Gender:F
Credentials:CASAC, CPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4521 ARTHUR KILL RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-1315
Mailing Address - Country:US
Mailing Address - Phone:718-605-1989
Mailing Address - Fax:187-984-1996
Practice Address - Street 1:4521 ARTHUR KILL RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-1315
Practice Address - Country:US
Practice Address - Phone:718-605-1989
Practice Address - Fax:718-605-1989
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-01
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCASAC-5378101YA0400X
NYCPP-158101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor