Healthcare Provider Details

I. General information

NPI: 1578771945
Provider Name (Legal Business Name): S. CRAIG MACDONALD LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 02/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 CEDAR ST
BANGOR ME
04401-6433
US

IV. Provider business mailing address

PO BOX 522
ELLSWORTH ME
04605-0522
US

V. Phone/Fax

Practice location:
  • Phone: 207-947-0366
  • Fax:
Mailing address:
  • Phone: 207-664-1994
  • Fax: 207-664-1994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC4801
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: