Provider Demographics
NPI:1184779894
Name:MCDONALD, SUSAN ELAINE (PHD,LSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELAINE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:PHD,LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-3535
Mailing Address - Country:US
Mailing Address - Phone:570-814-0969
Mailing Address - Fax:
Practice Address - Street 1:311 MARKET STREET, SUITE 6
Practice Address - Street 2:KINGSTON
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5068
Practice Address - Country:US
Practice Address - Phone:570-814-0969
Practice Address - Fax:570-514-4918
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW007916L104100000X
PACW0248881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker