Provider Demographics
NPI:1689854580
Name:MCDONOUGH, ESTHER (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ESTHER
Middle Name:
Last Name:MCDONOUGH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ESTHER
Other - Middle Name:
Other - Last Name:DUTRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1314 CAPE CORAL PKWY E
Mailing Address - Street 2:322
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-9696
Mailing Address - Country:US
Mailing Address - Phone:239-471-2928
Mailing Address - Fax:
Practice Address - Street 1:1314 CAPE CORAL PKWY E
Practice Address - Street 2:322
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-9696
Practice Address - Country:US
Practice Address - Phone:239-471-2928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 112781041C0700X
MO201000362391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA3233Medicare PIN
FL1689854580Medicare NSC