| Leo P Donovan Jr Phd Llc | |
|
239 Hamilton Ave Apt 8 Stamford CT 06902-3480 | |
| (203) 359-4560 | |
| (203) 359-4913 |
| Full Name | Leo P Donovan Jr Phd Llc |
|---|---|
| Speciality | Psychologist |
| Location | 239 Hamilton Ave Apt 8, Stamford, Connecticut |
| Authorized Official Name and Position | Leo P Donovan (MANAGER) |
| Authorized Official Contact | 2033594560 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Leo P Donovan Jr Phd Llc 239 Hamilton Ave Apt 8 Stamford CT 06902-3480 Ph: (203) 359-4560 | Leo P Donovan Jr Phd Llc 239 Hamilton Ave Apt 8 Stamford CT 06902-3480 Ph: (203) 359-4560 |
| NPI Number | 1760781371 |
|---|---|
| Provider Enumeration Date | 03/22/2011 |
| Last Update Date | 04/17/2011 |
| Medicare PECOS PAC ID | 1759565807 |
|---|---|
| Medicare Enrollment ID | O20110414000057 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760781371 | NPI | - | NPPES |
| 1316016611 | Other | NPI | |
| 004183274 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 560 (Connecticut) | Primary |
| Provider Name | Leo P Donovan |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1316016611 PECOS PAC ID: 8527242536 Enrollment ID: I20110420000040 |
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