Provider Demographics
NPI:1518253079
Name:MCDONAGH, MICHELLE KATHERINE (MSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:KATHERINE
Last Name:MCDONAGH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 FLORIDA ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-2635
Mailing Address - Country:US
Mailing Address - Phone:857-246-0993
Mailing Address - Fax:
Practice Address - Street 1:1613 BLUE HILL AVE
Practice Address - Street 2:
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-2123
Practice Address - Country:US
Practice Address - Phone:857-598-4774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical