Provider Demographics
NPI:1902090541
Name:DONNELLAN, LISA GRANT (MSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:GRANT
Last Name:DONNELLAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 S RIVER RD
Mailing Address - Street 2:UNIT 33
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6721
Mailing Address - Country:US
Mailing Address - Phone:603-552-1670
Mailing Address - Fax:603-552-1679
Practice Address - Street 1:40 S RIVER RD UNIT 33
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6721
Practice Address - Country:US
Practice Address - Phone:036-614-6016
Practice Address - Fax:603-462-5486
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH17321041C0700X
MA10273701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical