Provider Demographics
NPI:1104066323
Name:MACDONALD, MEGHAN THERESA (LICSW)
Entity type:Individual
Prefix:MISS
First Name:MEGHAN
Middle Name:THERESA
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-1268
Mailing Address - Country:US
Mailing Address - Phone:508-799-9432
Mailing Address - Fax:508-799-7911
Practice Address - Street 1:454 GROVE ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605
Practice Address - Country:US
Practice Address - Phone:508-799-9432
Practice Address - Fax:508-799-7911
Is Sole Proprietor?:No
Enumeration Date:2009-02-27
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1159651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical