Provider Demographics
NPI:1689779944
Name:MCDONALD, MATTHEW LEE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:LEE
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6155 INVERNESS TER
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:PA
Mailing Address - Zip Code:16415-3279
Mailing Address - Country:US
Mailing Address - Phone:814-490-8081
Mailing Address - Fax:814-836-8880
Practice Address - Street 1:3255 W 26TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-2507
Practice Address - Country:US
Practice Address - Phone:814-836-8888
Practice Address - Fax:814-836-8880
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003384101YP2500X
PAPS016423103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional