Provider Demographics
NPI:1588909733
Name:ELAINE M DONAGHUE LCSW, ACSW, RN, LLC
Entity type:Organization
Organization Name:ELAINE M DONAGHUE LCSW, ACSW, RN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DONAGHUE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, ACSW, RN, LLC
Authorized Official - Phone:561-279-2727
Mailing Address - Street 1:777 E ATLANTIC AVE
Mailing Address - Street 2:SUITE B4
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-5360
Mailing Address - Country:US
Mailing Address - Phone:561-279-2727
Mailing Address - Fax:561-732-9751
Practice Address - Street 1:777 E ATLANTIC AVE
Practice Address - Street 2:SUITE B4
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-5360
Practice Address - Country:US
Practice Address - Phone:561-279-2727
Practice Address - Fax:561-732-9751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 4422261QM0855X, 261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health