Provider Demographics
NPI:1841557972
Name:MCDONALD, MAUREEN MCCAFFERTY
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:MCCAFFERTY
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:
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 492
Mailing Address - Street 2:
Mailing Address - City:CLAVERACK
Mailing Address - State:NY
Mailing Address - Zip Code:12513-0492
Mailing Address - Country:US
Mailing Address - Phone:518-851-6605
Mailing Address - Fax:
Practice Address - Street 1:6154 ROUTE 9H & 23B
Practice Address - Street 2:
Practice Address - City:CLAVERACK
Practice Address - State:NY
Practice Address - Zip Code:12513-0492
Practice Address - Country:US
Practice Address - Phone:518-851-6605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-13
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004180-1224Z00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant