Kevan Lares Donaghy, LMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

081840 Issued in NY

Practice address

650 Madison St
Second Floor
Syracuse, NY 13210-2319

Phone

(315) 426-7694

Fax

(315) 426-6888

NPI assigned

Oct 15, 2010

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1287100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287100800000",
    "number": "1164732848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 S EDWARDS AVE",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132062912",
            "telephone_number": "315-569-0339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 MADISON ST",
            "address_2": "SECOND FLOOR",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132102319",
            "telephone_number": "315-426-7694",
            "fax_number": "315-426-6888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DONAGHY",
        "first_name": "KEVAN",
        "middle_name": "LARES",
        "name_prefix": "Mr.",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-10-15",
        "last_updated": "2010-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "081840",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph Bernard Domachowske, MD
• Sara Pauline Domachowske, FNP-C
• Cynthia Marie Domanski, RN
• David R Donaghy, LCSW
• Janine L Donaghy
• Zachary Donahue
• Jessica Ann Donaldson, FNP
• Kara Lynn Donato, P.N.P.
• Jordan Donegan, MD
• Keri Marie Donegan, DPT

• Clinical Social Worker in Syracuse, NY
• Providers in Syracuse, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.