Provider Demographics
NPI:1265250955
Name:CASTANEDA OLMEDO, DONOVAN RONALDO
Entity type:Individual
Prefix:MR
First Name:DONOVAN
Middle Name:RONALDO
Last Name:CASTANEDA OLMEDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 GREAT NECK RD STE 202
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5408
Mailing Address - Country:US
Mailing Address - Phone:646-397-1649
Mailing Address - Fax:
Practice Address - Street 1:111 GREAT NECK RD STE 202
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5408
Practice Address - Country:US
Practice Address - Phone:646-678-0724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-01
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health