Provider Demographics
NPI:1962841999
Name:MCDONALD, MICHELLE C (LICSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:C
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:L
Other - Last Name:CORF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:4 S MAIN ST STE 9
Mailing Address - Street 2:
Mailing Address - City:IPSWICH
Mailing Address - State:MA
Mailing Address - Zip Code:01938-2345
Mailing Address - Country:US
Mailing Address - Phone:978-041-2127
Mailing Address - Fax:978-338-4054
Practice Address - Street 1:4 S MAIN ST
Practice Address - Street 2:
Practice Address - City:IPSWICH
Practice Address - State:MA
Practice Address - Zip Code:01938-2345
Practice Address - Country:US
Practice Address - Phone:978-704-1212
Practice Address - Fax:978-338-4054
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-24
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2191531041C0700X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor