Provider Demographics
NPI:1235468182
Name:MCDONNELL, ROBERT A (LADC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:MCDONNELL
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROWNFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04010-4707
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19 RIVER RD
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:ME
Practice Address - Zip Code:04041-3516
Practice Address - Country:US
Practice Address - Phone:207-935-1078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-23
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC4844101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)