Provider Demographics
NPI:1992810303
Name:MARSHA MCDONALD, MSW, LICSW, LLC
Entity type:Organization
Organization Name:MARSHA MCDONALD, MSW, LICSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER, TREASURER AND SECRET
Authorized Official - Prefix:MS
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:BERNADETTE
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW
Authorized Official - Phone:952-285-2917
Mailing Address - Street 1:4005 W 65TH ST
Mailing Address - Street 2:122
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-1720
Mailing Address - Country:US
Mailing Address - Phone:952-285-2917
Mailing Address - Fax:
Practice Address - Street 1:4005 W 65TH ST
Practice Address - Street 2:122
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-1720
Practice Address - Country:US
Practice Address - Phone:952-285-2917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN148921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN258P4MCOtherBLUECROSS BLUE SHIELD
MN6271149OtherMEDICA