Provider Demographics
NPI:1366538449
Name:DONOWITZ, DENISE BRONZINO (PHD)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:BRONZINO
Last Name:DONOWITZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:DENISE
Other - Middle Name:
Other - Last Name:DONOWITZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:595 ROUTE 25A
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-2646
Mailing Address - Country:US
Mailing Address - Phone:631-744-4709
Mailing Address - Fax:631-821-3215
Practice Address - Street 1:595 ROUTE 25A
Practice Address - Street 2:SUITE 3
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-2646
Practice Address - Country:US
Practice Address - Phone:631-744-4709
Practice Address - Fax:631-821-3215
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011374-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV1J081Medicare ID - Type Unspecified