Provider Demographics
NPI:1780571125
Name:MACDONALD, SHAWN KENNETH (MS)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:KENNETH
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1A COMMONS DR UNIT 5
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3448
Mailing Address - Country:US
Mailing Address - Phone:603-255-3877
Mailing Address - Fax:
Practice Address - Street 1:112 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2931
Practice Address - Country:US
Practice Address - Phone:603-255-3877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health