Individual
DR. PAUL BERNARD DONOVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D
Contact information
Practice address
1640 OLD PECOS TRL, SUITE B, SANTA FE, NM 87505-4776
(505) 986-8866
(505) 983-1891
Mailing address
1640 OLD PECOS TRAIL, SUITE B, SANTA FE, NM 87505
(505) 986-8866
(505) 983-1891
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
#675
NM
103TH0100X
Health Service Psychologist
675
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
S3976.
—
NM
Enumeration date
05/12/2006
Last updated
12/29/2011
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