| Doctor Name: | DR. JOHN WILLIAM DONNELLY |
| NPI Number: | 1114023322 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | 048-0000678 |
| Business Practice Address: | 4185 St George Rd Williston, VT - 054957695 |
| Business Phone Number: | 8026517736 |
| Business Fax Number: | |
| Mailing Address: | 921 Ledgewood Dr, WILLISTON |
| State: | VT |
| Postal Code: | 054954414 |
| Phone Number: | 8028720551 |
| Fax Number: | |
| NPI Enumeration Date: | 09/15/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 048-0000678 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |