Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 184 | MA |
Y | 103T00000X | Psychologist | 184 | MA |
NPI | 1013961051 |
---|---|
Provider Name | James M. Donovan |
First Address | Wellesley, MA 02481-5420 |
Second Address | Wellesley, MA 02481-5420 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2006 |
Last Update Date | 07/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0014267 | NEIGHBORHOOD HEALTH PLAN (01) | MA |
669500 | TUFTS HEALTH PLAN (01) | MA |
W01086 | BLUE CROSS (01) | MA |