Provider Demographics
NPI:1649844663
Name:MACDOUGALL, ALICIA ANN (PSYD)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:ANN
Last Name:MACDOUGALL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 VERRY BROOK RD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03470-2341
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:163 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3131
Practice Address - Country:US
Practice Address - Phone:203-826-2567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-14
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004301103T00000X, 103TC0700X, 103T00000X
NH1634103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical