Provider Demographics
NPI:1710560057
Name:MCDONALD, MAUREEN CHRISTIN (LMSW)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:CHRISTIN
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36400 WOODWARD AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-0912
Mailing Address - Country:US
Mailing Address - Phone:248-973-7958
Mailing Address - Fax:
Practice Address - Street 1:36400 WOODWARD AVE STE 110
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-0912
Practice Address - Country:US
Practice Address - Phone:248-973-7958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801095073104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker