Provider Demographics
NPI:1528263126
Name:MACDONALD, VIRGINIA EILEEN (MA LPC)
Entity type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:EILEEN
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:MS
Other - First Name:GINA
Other - Middle Name:EILEEN
Other - Last Name:MACDONALD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA LPC
Mailing Address - Street 1:7 SOUTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405
Mailing Address - Country:US
Mailing Address - Phone:203-488-1886
Mailing Address - Fax:203-481-7634
Practice Address - Street 1:7 SOUTH MAIN ST
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405
Practice Address - Country:US
Practice Address - Phone:203-488-1886
Practice Address - Fax:203-481-7634
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000969101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT240000969CT01OtherANTHEM BEHAVIORAL HEALTH
CT7066592OtherAETNA BEHAVIORAL HEALTH
CT376663OtherMHN HEALTHNETS BEHAVIORAL