Provider Demographics
NPI:1063181410
Name:MCDONALD, DEIRDRE M
Entity type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:M
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 E 20TH ST APT 9E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-8213
Mailing Address - Country:US
Mailing Address - Phone:203-917-9815
Mailing Address - Fax:
Practice Address - Street 1:440 E 20TH ST APT 9E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-8213
Practice Address - Country:US
Practice Address - Phone:203-917-9815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist