Provider Demographics
NPI:1760360655
Name:MAGNUSSON, DONALD
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:MAGNUSSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 JAY CT
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-1918
Mailing Address - Country:US
Mailing Address - Phone:631-487-6805
Mailing Address - Fax:
Practice Address - Street 1:30 JAY CT
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-1918
Practice Address - Country:US
Practice Address - Phone:631-487-6805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool