Active NPI
Melissa Donovan, LMSW
- Addiction (Substance Use Disorder) Counselor
- New York, NY
National Provider Identifier
1477130508
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 107827
- Practice address
- 1369 Broadway
New York, NY 10018-7200 - Phone
- (212) 268-8830
- NPI assigned
- Mar 25, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 107827 | NY | Primary |
Addresses
Primary practice location
1369 Broadway
New York, NY 10018-7200
Mailing address
1369 Broadway
New York, NY 10018-7200
Phone (212) 268-8830
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Sep 17, 2023 through Sep 17, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 107827 | NY | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1616630400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1616630400000",
"number": "1477130508",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1369 BROADWAY",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100187200",
"telephone_number": "212-268-8830"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1369 BROADWAY",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100187200",
"telephone_number": "212-268-8830"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DONOVAN",
"first_name": "MELISSA",
"credential": "LMSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-03-25",
"last_updated": "2021-03-25",
"certification_date": "2021-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NY",
"license": "107827",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.