MEDICARE: MS. NICOLE R MCDONALD LCSWR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	078249	NY

General Provider Information

NPI Number	:	1548774805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NICOLE R MCDONALD LCSWR

Provider Business Mailing Address
First Line	:	PO BOX 10821
Second Line	:
City	:	NEWBURGH
State	:	NY
Zip	:	12552-0821
Country	:	US
Telephone Number	:	845-597-7404
Fax Number	:

Provider Business Practice Location Address
First Line	:	242 MAIN ST # 191
Second Line	:
City	:	BEACON
State	:	NY
Zip	:	12508-2732
Country	:	US
Telephone Number	:	845-597-7404
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/24/2017
Last Update Date	:	04/11/2022

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