Provider Demographics
NPI:1932461365
Name:MARIE MCDONALD, PSY.D., P.A.
Entity Type:Organization
Organization Name:MARIE MCDONALD, PSY.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:HETU
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:941-954-8978
Mailing Address - Street 1:51 WALLACE AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-6025
Mailing Address - Country:US
Mailing Address - Phone:941-954-8978
Mailing Address - Fax:
Practice Address - Street 1:51 WALLACE AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-6025
Practice Address - Country:US
Practice Address - Phone:941-954-8978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-12
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4236261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11529802OtherCAQH
FLG01AYOtherBCBS OF FL
FL11529802OtherCAQH