MEDICARE: MAXINE MCDONALD LCSW-R, CASAC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	5134	NY
2	1041C0700X	Clinical Social Worker	R042699-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110547FK	OTHER	NY	PREFERRED CARE

General Provider Information

NPI Number	:	1609831106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAXINE MCDONALD LCSW-R, CASAC

Provider Business Mailing Address
First Line	:	2139 EVERGREEN LN
Second Line	:
City	:	ONTARIO
State	:	NY
Zip	:	14519-9705
Country	:	US
Telephone Number	:	585-330-8891
Fax Number	:

Provider Business Practice Location Address
First Line	:	2139 EVERGREEN LN
Second Line	:
City	:	ONTARIO
State	:	NY
Zip	:	14519-9705
Country	:	US
Telephone Number	:	585-330-8891
Fax Number	:

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

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	09/11/2025

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