Provider Demographics
NPI:1811395148
Name:MCDONALD, DENISE (IBCLC)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 BALTIC ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-6077
Mailing Address - Country:US
Mailing Address - Phone:718-596-4777
Mailing Address - Fax:
Practice Address - Street 1:142 BALTIC ST APT 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-6077
Practice Address - Country:US
Practice Address - Phone:718-596-4777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYL-61203174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN