Provider Demographics
NPI:1558563452
Name:MCDONALD, ELISABETH S (MS)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:S
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 HOWE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH SALEM
Mailing Address - State:NY
Mailing Address - Zip Code:10590-1308
Mailing Address - Country:US
Mailing Address - Phone:914-763-8997
Mailing Address - Fax:914-763-8284
Practice Address - Street 1:23 PARKWAY
Practice Address - Street 2:
Practice Address - City:KATONAH
Practice Address - State:NY
Practice Address - Zip Code:10536-1505
Practice Address - Country:US
Practice Address - Phone:914-907-5515
Practice Address - Fax:914-763-8284
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000573102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst