Provider Demographics
NPI:1609480193
Name:MACDOUGALL, MARGUERITE ROBERTA (LCSW)
Entity Type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:ROBERTA
Last Name:MACDOUGALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 TIOGA AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5153
Mailing Address - Country:US
Mailing Address - Phone:570-690-0447
Mailing Address - Fax:
Practice Address - Street 1:200 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657-1229
Practice Address - Country:US
Practice Address - Phone:570-690-0447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-02
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0213011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical