Provider Demographics
NPI:1942537212
Name:G TODD MCDONALD APRN LLC
Entity Type:Organization
Organization Name:G TODD MCDONALD APRN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:860-545-7229
Mailing Address - Street 1:26 ELAINE MARY DR
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-1717
Mailing Address - Country:US
Mailing Address - Phone:860-545-7229
Mailing Address - Fax:860-545-7002
Practice Address - Street 1:400 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-3351
Practice Address - Country:US
Practice Address - Phone:860-545-7229
Practice Address - Fax:860-545-7002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-07
Last Update Date:2009-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001698101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004016986Medicaid
CTP35576Medicare UPIN
CT004016986Medicaid