Provider Demographics
NPI:1457386633
Name:MCDONALD, ROSE ANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROSE
Middle Name:ANN
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5108 BROADWAY ST
Mailing Address - Street 2:ROOM 237
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-5746
Mailing Address - Country:US
Mailing Address - Phone:210-882-7696
Mailing Address - Fax:210-832-9053
Practice Address - Street 1:5108 BROADWAY ST
Practice Address - Street 2:ROOM 237
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-5746
Practice Address - Country:US
Practice Address - Phone:210-882-7696
Practice Address - Fax:210-832-9053
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24313103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX612253Medicare ID - Type Unspecified