Provider Demographics
NPI:1073968905
Name:MACDONALD, LISA MARIE (MSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:CROWLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:4 CAMPBELL CIR
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-6838
Mailing Address - Country:US
Mailing Address - Phone:207-985-9939
Mailing Address - Fax:
Practice Address - Street 1:4 CAMPBELL CIR
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-6838
Practice Address - Country:US
Practice Address - Phone:207-985-9939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-28
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASW110393-11041C0700X
MELC89561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical