Provider Demographics
NPI:1417236373
Name:MACDONALD, ABIGAIL SHAW (MSW, LICSW)
Entity Type:Individual
Prefix:MRS
First Name:ABIGAIL
Middle Name:SHAW
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:MISS
Other - First Name:ABIGAIL
Other - Middle Name:JULIA
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:57 ALLSTON ST
Mailing Address - Street 2:#1
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-4516
Mailing Address - Country:US
Mailing Address - Phone:617-475-0879
Mailing Address - Fax:617-726-2626
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:WAC 037
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-724-4008
Practice Address - Fax:617-726-2626
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1142901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical