Provider Demographics
NPI:1669513412
Name:CHALIFOUX, DONNA M (MS)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:M
Last Name:CHALIFOUX
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 CHESTNUT ST
Mailing Address - Street 2:APT 2
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-2217
Mailing Address - Country:US
Mailing Address - Phone:978-407-0699
Mailing Address - Fax:
Practice Address - Street 1:205 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-2781
Practice Address - Country:US
Practice Address - Phone:978-632-2321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health