Provider Demographics
NPI:1609386911
Name:MACDONALD, KARL
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 COBORO RD.
Mailing Address - Street 2:
Mailing Address - City:STETSON
Mailing Address - State:ME
Mailing Address - Zip Code:04488
Mailing Address - Country:US
Mailing Address - Phone:207-570-5550
Mailing Address - Fax:
Practice Address - Street 1:56 COBORO RD.
Practice Address - Street 2:
Practice Address - City:STETSON
Practice Address - State:ME
Practice Address - Zip Code:04488
Practice Address - Country:US
Practice Address - Phone:207-570-5550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker