Provider Demographics
NPI:1083824171
Name:MACDONALD, MEGEN ANNE (MA)
Entity Type:Individual
Prefix:MISS
First Name:MEGEN
Middle Name:ANNE
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 S TAMIAMI TRL
Mailing Address - Street 2:STE 202
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-7840
Mailing Address - Country:US
Mailing Address - Phone:941-400-8736
Mailing Address - Fax:
Practice Address - Street 1:950 S TAMIAMI TRL
Practice Address - Street 2:STE 202
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-7840
Practice Address - Country:US
Practice Address - Phone:941-400-8736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9445101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health