Individual
SHANE WILLIAM MACDONALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
20 STEARNS AVE, MEDFORD, MA 02155-5620
(860) 964-9398
Mailing address
20 STEARNS AVE, MEDFORD, MA 02155-5620
(860) 964-9398
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
223903
MA
Other
Enumeration date
11/05/2020
Last updated
11/05/2020
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