1588909733 NPI number — ELAINE M DONAGHUE LCSW, ACSW, RN, LLC

Table of content: (NPI 1588909733)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588909733 NPI number — ELAINE M DONAGHUE LCSW, ACSW, RN, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELAINE M DONAGHUE LCSW, ACSW, RN, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588909733
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
777 E ATLANTIC AVE
Provider Second Line Business Mailing Address:
SUITE B4
Provider Business Mailing Address City Name:
DELRAY BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33483-5360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-279-2727
Provider Business Mailing Address Fax Number:
561-732-9751

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
777 E ATLANTIC AVE
Provider Second Line Business Practice Location Address:
SUITE B4
Provider Business Practice Location Address City Name:
DELRAY BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33483-5360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-279-2727
Provider Business Practice Location Address Fax Number:
561-732-9751
Provider Enumeration Date:
11/28/2012

Additional Information

Authorized Official

Authorized Official Last Name:
DONAGHUE
Authorized Official First Name:
ELAINE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PSYCHOTHERAPIST
Authorized Official Telephone Number:
561-279-2727

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X , with the licence number:  SW 4422 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0855X , with the licence number: SW 4422 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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