Provider Demographics
NPI:1013103407
Name:MACDONALD, JENNIFER P (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:P
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 WOBURN ST
Mailing Address - Street 2:#12B
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-2903
Mailing Address - Country:US
Mailing Address - Phone:781-944-0238
Mailing Address - Fax:781-944-5100
Practice Address - Street 1:36 WOBURN ST
Practice Address - Street 2:#12B
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-2903
Practice Address - Country:US
Practice Address - Phone:781-944-0238
Practice Address - Fax:781-944-5100
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7574103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical