Provider Demographics
NPI:1801610837
Name:MCDONOUGH, SUZANNE (PSYD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:
Last Name:MCDONOUGH
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 1:1206 CONSTANTINE CT
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-6838
Mailing Address - Country:US
Mailing Address - Phone:410-707-6772
Mailing Address - Fax:
Practice Address - Street 1:5609 SEFTON AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214-2300
Practice Address - Country:US
Practice Address - Phone:443-642-2119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool