Basic Information
| Provider Information | |||||||||
| NPI: | 1205925666 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MACDONNELL | ||||||||
| FirstName: | MARYANNE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.S., C.A.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 71 MASSACHUSETTS AVE | ||||||||
| Address2: | |||||||||
| City: | LONGMEADOW | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011063022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135652621 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 110 MAPLE ST | ||||||||
| Address2: | CHILD GUIDANCE CLINIC | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011051864 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137370960 | ||||||||
| FaxNumber: | 4137373000 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.