Healthcare Provider Details

I. General information

NPI: 1831269364
Provider Name (Legal Business Name): DENESE MCDONALD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48TH MDG, RAF LAKENHEATH UNIT 5115
APO AE
09461
US

IV. Provider business mailing address

PSC 50 BOX 52
APO AE
09494-0001
US

V. Phone/Fax

Practice location:
  • Phone: 314-226-8124
  • Fax:
Mailing address:
  • Phone: 314-236-8566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8075851-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: