Healthcare Provider Details

I. General information

NPI: 1558981928
Provider Name (Legal Business Name): JACQUELYN MACDOUGALL LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2020
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 DERBY ST # 254
HINGHAM MA
02043-4216
US

IV. Provider business mailing address

486 SUMMER ST
WEYMOUTH MA
02188-1218
US

V. Phone/Fax

Practice location:
  • Phone: 781-423-3523
  • Fax:
Mailing address:
  • Phone: 781-424-6422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11654
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: