Provider Demographics
NPI:1548041759
Name:MCDONALD, EILEEN PATRICIA (PMHNP)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:PATRICIA
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 LOUISIANA ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-1218
Mailing Address - Country:US
Mailing Address - Phone:602-769-0146
Mailing Address - Fax:
Practice Address - Street 1:46 LOUISIANA ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-1218
Practice Address - Country:US
Practice Address - Phone:602-769-0146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF404833-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty