Healthcare Provider Details

I. General information

NPI: 1538594825
Provider Name (Legal Business Name): MISS EMILY KATHRYN MCDONALD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2013
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39155 LIBERTY ST
FREMONT CA
94538-1513
US

IV. Provider business mailing address

2415 SAN RAMON VALLEY BLVD STE 4
SAN RAMON CA
94583-1651
US

V. Phone/Fax

Practice location:
  • Phone: 510-795-2434
  • Fax:
Mailing address:
  • Phone: 510-660-7909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: