Provider Demographics
NPI:1578739652
Name:MACDONALD, SHAWN V (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:V
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 EAST-WEST HWY
Mailing Address - Street 2:SUITE 1028
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-4511
Mailing Address - Country:US
Mailing Address - Phone:301-358-6421
Mailing Address - Fax:301-907-3241
Practice Address - Street 1:4400 EAST-WEST HWY
Practice Address - Street 2:SUITE 1028
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4511
Practice Address - Country:US
Practice Address - Phone:301-358-6421
Practice Address - Fax:301-907-3241
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2720101YP2500X
MD04666103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDM8610001OtherBLUECROSS/BLUESHIELD
MD633364MDOtherVALUE OPTIONS
MD024811800Medicaid