Provider Demographics
NPI:1386173383
Name:JOHN MCDONALD LCSW LLC
Entity type:Organization
Organization Name:JOHN MCDONALD LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:INFELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-679-6412
Mailing Address - Street 1:47 MARKHAM CIR
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-5040
Mailing Address - Country:US
Mailing Address - Phone:201-503-1247
Mailing Address - Fax:
Practice Address - Street 1:297 KINDERKAMACK RD
Practice Address - Street 2:
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649-1538
Practice Address - Country:US
Practice Address - Phone:201-503-1247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-05
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053584001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty