Provider Demographics
NPI:1245369578
Name:MACDONALD, VIRGINIA M (PHD)
Entity type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:M
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 1:134 RICHFIELD LN
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-9625
Mailing Address - Country:US
Mailing Address - Phone:802-338-6374
Mailing Address - Fax:
Practice Address - Street 1:321 MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:WINOOSKI
Practice Address - State:VT
Practice Address - Zip Code:05404-1380
Practice Address - Country:US
Practice Address - Phone:802-338-6374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT048.0000572103TC0700X
VT0000572103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN0549Medicaid
VTVN0549Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER