Provider Demographics
NPI:1225349590
Name:MCDONOUGH, STEPHANIE A (LMHC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:MCDONOUGH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 WHITCOMB AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01460-1405
Mailing Address - Country:US
Mailing Address - Phone:978-501-7841
Mailing Address - Fax:
Practice Address - Street 1:290 LITTLETON RD
Practice Address - Street 2:SUITE 1A
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-3406
Practice Address - Country:US
Practice Address - Phone:978-540-5978
Practice Address - Fax:978-319-9293
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-01
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4999101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health