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NPI Code Detail

MEDICARE: MARY E MACDONALD LCSW

MEDICARE: MARY E MACDONALD LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker992659CO

General Provider Information

NPI Number : 1255389433
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY E MACDONALD LCSW
Provider Business Mailing Address
First Line : 1088 E CLEVELAND AVE
Second Line :
City : FRUITA
State : CO
Zip : 81521-3105
Country : US
Telephone Number : 970-858-8295
Fax Number :
Provider Business Practice Location Address
First Line : 2121 NORTH AVE
Second Line :
City : GRAND JUNCTION
State : CO
Zip : 81501-6428
Country : US
Telephone Number : 970-242-0731
Fax Number : 970-256-8905
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2006
Last Update Date : 11/21/2008

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Directions to “ MARY E MACDONALD LCSW” Practice Location

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