Provider Demographics
NPI:1003605643
Name:MACDONOUGH, SYDNEY A
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:A
Last Name:MACDONOUGH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CONRAD CT
Mailing Address - Street 2:
Mailing Address - City:BLAIRSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07825-2100
Mailing Address - Country:US
Mailing Address - Phone:908-399-9629
Mailing Address - Fax:
Practice Address - Street 1:1 CONRAD CT
Practice Address - Street 2:
Practice Address - City:BLAIRSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07825-2100
Practice Address - Country:US
Practice Address - Phone:908-399-9629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician