Provider Demographics
NPI:1497236160
Name:MACDONALD, CORY EDWARD
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:EDWARD
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 GROVE ST APT 325
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:MA
Mailing Address - Zip Code:02370-2345
Mailing Address - Country:US
Mailing Address - Phone:339-788-8562
Mailing Address - Fax:
Practice Address - Street 1:36 CORDAGE PARK CIR STE 305
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-7332
Practice Address - Country:US
Practice Address - Phone:339-788-8562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health