Provider Demographics
NPI:1699105502
Name:DONOVAN, CLEARY M (PSY D)
Entity type:Individual
Prefix:DR
First Name:CLEARY
Middle Name:M
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:4951 BUSINESS PARK BLVD
Mailing Address - Street 2:ANCHORAGE NEIGHBORHOOD HEALTH CENTER
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503
Mailing Address - Country:US
Mailing Address - Phone:907-743-7613
Mailing Address - Fax:907-743-7252
Practice Address - Street 1:4951 BUSINESS PARK BLVD
Practice Address - Street 2:ANCHORAGE NEIGHBORHOOD HEALTH CENTER
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503
Practice Address - Country:US
Practice Address - Phone:907-743-7613
Practice Address - Fax:907-743-7252
Is Sole Proprietor?:No
Enumeration Date:2013-11-14
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK598103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical