Provider Demographics
NPI:1427571553
Name:THOMAS-MACDONALD, ANN J (M ED, LSW)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:J
Last Name:THOMAS-MACDONALD
Suffix:
Gender:F
Credentials:M ED, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 KILDARE ST
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023-9283
Mailing Address - Country:US
Mailing Address - Phone:740-507-4217
Mailing Address - Fax:
Practice Address - Street 1:15 N 3RD ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-5550
Practice Address - Country:US
Practice Address - Phone:740-349-7511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-20
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
OH104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker