Basic Information
| Provider Information | |||||||||
| NPI: | 1417588542 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FONES | ||||||||
| FirstName: | DONOVAN | ||||||||
| MiddleName: | DAVID | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1487 HUNTINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | SOUTH SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94080 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6508775628 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 31 TOWER ROAD | ||||||||
| Address2: | |||||||||
| City: | SAN MATEO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503125320 | ||||||||
| FaxNumber: | 6505722414 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2020 | ||||||||
| LastUpdateDate: | 01/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LCSW26295 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.