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Individual

CAJ L MACDONALD

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
899 RIVERSIDE ST, PORTLAND, ME 04103-1070
(207) 871-1235
(207) 879-6161
Mailing address
899 RIVERSIDE ST, PORTLAND, ME 04103-1070
(207) 871-1200
(207) 871-1232

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LC5834
ME

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
CAC2986
CERT ALCOHOL & D
ME
01
RB9
ANTHEM
ME
Enumeration date
11/20/2006
Last updated
02/08/2013
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