Provider Demographics
NPI:1174840425
Name:MACDONALD, ALEXANDER 'SANDY' FREDERICK (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER 'SANDY'
Middle Name:FREDERICK
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:SANDY
Other - Middle Name:
Other - Last Name:MACDONALD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 1735
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97709-1735
Mailing Address - Country:US
Mailing Address - Phone:541-647-8109
Mailing Address - Fax:
Practice Address - Street 1:754 NW BROADWAY ST
Practice Address - Street 2:SUITE #201
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-2776
Practice Address - Country:US
Practice Address - Phone:541-647-8109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-27
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL37521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical