Provider Demographics
NPI:1144581935
Name:MACDONALD, KIM MARIE
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:MARIE
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7270 LAKEVIEW CT
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-9711
Mailing Address - Country:US
Mailing Address - Phone:716-693-4501
Mailing Address - Fax:
Practice Address - Street 1:7270 LAKEVIEW CT
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-9711
Practice Address - Country:US
Practice Address - Phone:716-693-4501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool