Provider Demographics
NPI:1194121509
Name:MACDONALD, DEBRA JANE
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:JANE
Last Name:MACDONALD
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 1:395 LOVELL ST # 2
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01602-3313
Mailing Address - Country:US
Mailing Address - Phone:508-816-1514
Mailing Address - Fax:
Practice Address - Street 1:395 LOVELL ST # 2
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602-3313
Practice Address - Country:US
Practice Address - Phone:508-816-1514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-12
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker