Provider Demographics
NPI:1962626689
Name:MCDONOUGH, SHEILA BRIDGET (LCMHC)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:BRIDGET
Last Name:MCDONOUGH
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 MIDDLE ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-1905
Mailing Address - Country:US
Mailing Address - Phone:603-665-9590
Mailing Address - Fax:603-665-9590
Practice Address - Street 1:121 MIDDLE ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1905
Practice Address - Country:US
Practice Address - Phone:603-665-9590
Practice Address - Fax:603-665-9590
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH97101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH14Y001075NH01OtherANTHEM BCBS PROVIDER
NH30008381Medicaid