Provider Demographics
NPI:1922754183
Name:FONTANA, DONNA M (LCSW)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:M
Last Name:FONTANA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 631
Mailing Address - Street 2:
Mailing Address - City:OCEAN GATE
Mailing Address - State:NJ
Mailing Address - Zip Code:08740-0631
Mailing Address - Country:US
Mailing Address - Phone:908-415-8776
Mailing Address - Fax:
Practice Address - Street 1:52 HYERS ST
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-7465
Practice Address - Country:US
Practice Address - Phone:908-415-8776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-26
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC06486400104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker