Provider Demographics
NPI:1457335663
Name:MCDONNELL, FREDDA G (LICSW)
Entity Type:Individual
Prefix:MS
First Name:FREDDA
Middle Name:G
Last Name:MCDONNELL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:FREDDA
Other - Middle Name:G
Other - Last Name:SKLAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:PO BOX 1114
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02347-1114
Mailing Address - Country:US
Mailing Address - Phone:508-763-9299
Mailing Address - Fax:508-763-9517
Practice Address - Street 1:5 WATSON RD
Practice Address - Street 2:STE 206
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-3900
Practice Address - Country:US
Practice Address - Phone:617-489-1521
Practice Address - Fax:781-862-0325
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1044511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO2582Medicare ID - Type Unspecified