Healthcare Provider Details

I. General information

NPI: 1558208322
Provider Name (Legal Business Name): OLIVIA MCDONALD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 990281
BOSTON MA
02199-0281
US

IV. Provider business mailing address

55 HOBART ST
BRAINTREE MA
02184-3420
US

V. Phone/Fax

Practice location:
  • Phone: 617-922-2370
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLABA10000822
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: