Provider Demographics
NPI:1205925666
Name:MACDONNELL, MARYANNE (MS, CAS)
Entity type:Individual
Prefix:MS
First Name:MARYANNE
Middle Name:
Last Name:MACDONNELL
Suffix:
Gender:F
Credentials:MS, CAS
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Mailing Address - Street 1:71 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-3022
Mailing Address - Country:US
Mailing Address - Phone:413-565-2621
Mailing Address - Fax:
Practice Address - Street 1:110 MAPLE ST
Practice Address - Street 2:CHILD GUIDANCE CLINIC
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01105-1864
Practice Address - Country:US
Practice Address - Phone:413-737-0960
Practice Address - Fax:413-737-3000
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health