Provider Demographics
NPI:1669609335
Name:MACDONALD, HAILEY ELIZABETH (LICSW)
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:ELIZABETH
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:HAILEY
Other - Middle Name:ELIZABETH
Other - Last Name:GRANGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:29 EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-2556
Mailing Address - Country:US
Mailing Address - Phone:978-515-5381
Mailing Address - Fax:
Practice Address - Street 1:29 EMERSON AVE
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930
Practice Address - Country:US
Practice Address - Phone:978-515-5381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-19
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1177941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical