Provider Demographics
NPI:1912568379
Name:MCDONOUGH, HAILEY KATHLEEN (BEHAVIOR TECHNICIAN)
Entity Type:Individual
Prefix:MISS
First Name:HAILEY
Middle Name:KATHLEEN
Last Name:MCDONOUGH
Suffix:
Gender:F
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 BRIDGE GATE
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-6377
Mailing Address - Country:US
Mailing Address - Phone:508-287-8692
Mailing Address - Fax:
Practice Address - Street 1:16 BRIDGE GATE
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-6377
Practice Address - Country:US
Practice Address - Phone:508-287-8692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician