Provider Demographics
NPI:1578681516
Name:MACDONALD, MARYJEAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARYJEAN
Middle Name:
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 ROUTE 100
Mailing Address - Street 2:
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536-3242
Mailing Address - Country:US
Mailing Address - Phone:914-232-8646
Mailing Address - Fax:
Practice Address - Street 1:85 OLD KINGS HWY N
Practice Address - Street 2:SOUTHFIED CENTER FOR DEVELOPMENT
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-4724
Practice Address - Country:US
Practice Address - Phone:914-588-9203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002249103TC0700X
NY011988-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical