Provider Demographics
NPI:1336290717
Name:MACDOUGALL, MARTA RUSTEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARTA
Middle Name:RUSTEN
Last Name:MACDOUGALL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:498 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-2636
Mailing Address - Country:US
Mailing Address - Phone:215-657-1810
Mailing Address - Fax:
Practice Address - Street 1:512 WEST AVE
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-2725
Practice Address - Country:US
Practice Address - Phone:215-885-1835
Practice Address - Fax:215-885-8510
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015570103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical