Provider Demographics
NPI:1487899431
Name:MACDONALD, BRUCE (LICSW)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 PARKER ST
Mailing Address - Street 2:APT 3
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-2224
Mailing Address - Country:US
Mailing Address - Phone:617-876-6332
Mailing Address - Fax:
Practice Address - Street 1:ONE BROOKLINE PLACE
Practice Address - Street 2:SUITE 426
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7224
Practice Address - Country:US
Practice Address - Phone:617-876-6332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1111741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical