Provider Demographics
NPI:1962735522
Name:DONOVAN, CARI LEE (ACSW)
Entity type:Individual
Prefix:MS
First Name:CARI
Middle Name:LEE
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:CARI
Other - Middle Name:LEE
Other - Last Name:MERRITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACSW
Mailing Address - Street 1:684 ELLIS ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-8090
Mailing Address - Country:US
Mailing Address - Phone:415-409-4611
Mailing Address - Fax:
Practice Address - Street 1:684 ELLIS ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-8090
Practice Address - Country:US
Practice Address - Phone:415-409-4611
Practice Address - Fax:415-409-4617
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA321321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1720385032Medicaid
CA1942507835Medicaid