Provider Demographics
NPI:1548774805
Name:MCDONALD, NICOLE R (LCSWR)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:R
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10821
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12552-0821
Mailing Address - Country:US
Mailing Address - Phone:845-597-7404
Mailing Address - Fax:
Practice Address - Street 1:242 MAIN ST # 191
Practice Address - Street 2:
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508-2732
Practice Address - Country:US
Practice Address - Phone:845-597-7404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-24
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0782491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical