Provider Demographics
NPI:1235328170
Name:MACDONALD, MARIAN L (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIAN
Middle Name:L
Last Name:MACDONALD
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 1:16 ARMORY ST
Mailing Address - Street 2:STE 27
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3857
Mailing Address - Country:US
Mailing Address - Phone:413-585-5995
Mailing Address - Fax:
Practice Address - Street 1:16 ARMORY ST
Practice Address - Street 2:STE 27
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3857
Practice Address - Country:US
Practice Address - Phone:413-585-5995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2527103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical