Provider Demographics
NPI:1992907414
Name:MCDONALD, LYNETTE JOY JACKSON (LCSW)
Entity type:Individual
Prefix:
First Name:LYNETTE
Middle Name:JOY JACKSON
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1928 BROOKSTONE ST
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-1765
Mailing Address - Country:US
Mailing Address - Phone:909-792-2206
Mailing Address - Fax:
Practice Address - Street 1:325 W HOSPITALITY LN
Practice Address - Street 2:SUITE 312
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3243
Practice Address - Country:US
Practice Address - Phone:909-386-5537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA236581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical