Provider Demographics
NPI:1578748265
Name:MAGDER, DONALD JAY (MA, LLP)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:JAY
Last Name:MAGDER
Suffix:
Gender:M
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16000 W 9 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4808
Mailing Address - Country:US
Mailing Address - Phone:248-703-6943
Mailing Address - Fax:
Practice Address - Street 1:29877 TELEGRAPH RD STE 107
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-7658
Practice Address - Country:US
Practice Address - Phone:248-703-6943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-01
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013393103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical