Healthcare Provider Details

I. General information

NPI: 1720652241
Provider Name (Legal Business Name): MATTHEW JOHN MCDONALD LLMSW, MSW, BSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S CRAPO ST
MOUNT PLEASANT MI
48858-2941
US

IV. Provider business mailing address

301 S CRAPO ST
MOUNT PLEASANT MI
48858-2941
US

V. Phone/Fax

Practice location:
  • Phone: 989-772-5938
  • Fax: 989-773-5368
Mailing address:
  • Phone: 989-772-5938
  • Fax: 989-773-5368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number680110986
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: