Provider Demographics
NPI:1487116018
Name:DONAGHY, JEAN MARIE
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:MARIE
Last Name:DONAGHY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12640 BRIARGLEN LOOP UNIT F
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:CA
Mailing Address - Zip Code:90680-4122
Mailing Address - Country:US
Mailing Address - Phone:714-561-1932
Mailing Address - Fax:
Practice Address - Street 1:12640 BRIARGLEN LOOP UNIT F
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:CA
Practice Address - Zip Code:90680-4122
Practice Address - Country:US
Practice Address - Phone:714-561-1932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician