Provider Demographics
NPI:1679056055
Name:MCDONALD, CHARLENE SUE (LICSW)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:SUE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220R FORBES RD
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-2702
Mailing Address - Country:US
Mailing Address - Phone:617-571-1469
Mailing Address - Fax:
Practice Address - Street 1:220R FORBES RD
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-2702
Practice Address - Country:US
Practice Address - Phone:617-571-1469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1187901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical