Provider Demographics
NPI:1710532817
Name:MACDONALD, ROBERT WILLIAM JR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:WILLIAM
Last Name:MACDONALD
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:ROBERT
Other - Middle Name:WILLIAM
Other - Last Name:MACDONALD
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:416 ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-4100
Mailing Address - Country:US
Mailing Address - Phone:401-499-0299
Mailing Address - Fax:
Practice Address - Street 1:153 SUMMER ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4011
Practice Address - Country:US
Practice Address - Phone:401-276-4375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW006611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical