Provider Demographics
NPI:1831443290
Name:BARBARA J MCDOUGALL, PSYD, PA
Entity type:Organization
Organization Name:BARBARA J MCDOUGALL, PSYD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:JEANNE
Authorized Official - Last Name:MCDOUGALL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:904-531-9752
Mailing Address - Street 1:623 OAK ST
Mailing Address - Street 2:
Mailing Address - City:GREEN COVE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32043-4313
Mailing Address - Country:US
Mailing Address - Phone:904-531-9752
Mailing Address - Fax:904-531-5149
Practice Address - Street 1:623 OAK STREET
Practice Address - Street 2:
Practice Address - City:GREEN COVE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32043
Practice Address - Country:US
Practice Address - Phone:904-531-9752
Practice Address - Fax:904-531-5149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7136103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL828926000Medicaid
FL75044Medicare UPIN