Provider Demographics
NPI:1134496722
Name:MCDONOUGH, ERIN MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:MARIE
Last Name:MCDONOUGH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 FRANKLIN AVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-2938
Mailing Address - Country:US
Mailing Address - Phone:516-240-8212
Mailing Address - Fax:
Practice Address - Street 1:1044 FRANKLIN AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-2938
Practice Address - Country:US
Practice Address - Phone:516-240-8212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-26
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019227103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist