Provider Demographics
NPI:1295885390
Name:MACDONALD, CATHERINE MARIE (NP)
Entity type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:MARIE
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 SHEPHERDS PATH
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-6215
Mailing Address - Country:US
Mailing Address - Phone:781-834-6378
Mailing Address - Fax:
Practice Address - Street 1:20 FORSYTHE AVE
Practice Address - Street 2:
Practice Address - City:SOUTH YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02664-1814
Practice Address - Country:US
Practice Address - Phone:508-398-5155
Practice Address - Fax:508-398-3478
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA122825261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone