Provider Demographics
NPI:1407620628
Name:MCDONALD, EMILY ANNE (MS, LCMHC)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:ANNE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MS, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 DALTON DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-3103
Mailing Address - Country:US
Mailing Address - Phone:973-477-6513
Mailing Address - Fax:
Practice Address - Street 1:20 W CANAL ST STE C2-3
Practice Address - Street 2:
Practice Address - City:WINOOSKI
Practice Address - State:VT
Practice Address - Zip Code:05404-2131
Practice Address - Country:US
Practice Address - Phone:973-477-6513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0135582101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health