Healthcare Provider Details

I. General information

NPI: 1417494469
Provider Name (Legal Business Name): MICHELLE MCDONALD PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE MOSHIER

II. Dates (important events)

Enumeration Date: 01/30/2017
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40900 MERCHANTS LN UNIT 207
LEONARDTOWN MD
20650-3796
US

IV. Provider business mailing address

40900 MERCHANTS LN UNIT 207
LEONARDTOWN MD
20650-3796
US

V. Phone/Fax

Practice location:
  • Phone: 518-369-5282
  • Fax: 301-560-4954
Mailing address:
  • Phone: 518-369-5282
  • Fax: 301-560-4954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY9795
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number07467
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: