Provider Demographics
NPI:1568944106
Name:MCGONEGAL, DANIELLE NOLAN (LICSW)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:NOLAN
Last Name:MCGONEGAL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 KELLY RD APT 1
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-4404
Mailing Address - Country:US
Mailing Address - Phone:617-823-2253
Mailing Address - Fax:
Practice Address - Street 1:8 KELLY RD APT 1
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-4404
Practice Address - Country:US
Practice Address - Phone:617-823-2253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1149721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical