Provider Demographics
NPI:1730301938
Name:MACDONALD, PATRICIA B (LCPC, RN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:B
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:LCPC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7242
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04112-7242
Mailing Address - Country:US
Mailing Address - Phone:207-776-0533
Mailing Address - Fax:207-767-2327
Practice Address - Street 1:884 BROADWAY
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-4371
Practice Address - Country:US
Practice Address - Phone:207-776-0533
Practice Address - Fax:207-767-2327
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC3207101YP2500X
MER028007163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered163W00000XNursing Service ProvidersRegistered Nurse