Provider Demographics
NPI:1598743452
Name:MACDONALD, KAREN A (PSY D)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:A
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:A
Other - Last Name:FRIED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:116 S LINCOLN DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MO
Mailing Address - Zip Code:63379-1418
Mailing Address - Country:US
Mailing Address - Phone:636-528-1996
Mailing Address - Fax:636-528-1833
Practice Address - Street 1:116 S LINCOLN DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MO
Practice Address - Zip Code:63379-1418
Practice Address - Country:US
Practice Address - Phone:636-528-1996
Practice Address - Fax:636-528-1833
Is Sole Proprietor?:No
Enumeration Date:2006-01-02
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01527103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO493457824Medicaid
MO493457824Medicaid