Provider Demographics
NPI:1043058597
Name:DONAGHUE, MARINA DANIELLE (MHC-LP)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:DANIELLE
Last Name:DONAGHUE
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:MARINA
Other - Middle Name:DANIELLE
Other - Last Name:DOTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29 E CAYUGA ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-1241
Mailing Address - Country:US
Mailing Address - Phone:315-326-4100
Mailing Address - Fax:
Practice Address - Street 1:522 S 4TH ST STE 200
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-2941
Practice Address - Country:US
Practice Address - Phone:315-598-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP129636101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health