Provider Demographics
NPI:1285124461
Name:DONALD, ANN RANDOLPH (PHD)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:RANDOLPH
Last Name:DONALD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 MATAWANAKEE TRL
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01460-1310
Mailing Address - Country:US
Mailing Address - Phone:978-486-9284
Mailing Address - Fax:
Practice Address - Street 1:91 MATAWANAKEE TRL
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:MA
Practice Address - Zip Code:01460-1310
Practice Address - Country:US
Practice Address - Phone:978-486-9284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4736103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical