Healthcare Provider Details

I. General information

NPI: 1891451456
Provider Name (Legal Business Name): KATHLEEN M MCDONALD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2021
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MGB-SALEM HOSPITAL MENTAL HEALTH OUTPATIENT CLINIC 55 HIGHLAND AVENUE, SUITE 201
SALEM MA
01970
US

IV. Provider business mailing address

34 WALTER ST APT 1
SALEM MA
01970-2464
US

V. Phone/Fax

Practice location:
  • Phone: 978-825-6673
  • Fax:
Mailing address:
  • Phone: 978-257-2261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1142297
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: