| Doctor Name: | JESSICA MACDONALD |
| NPI Number: | 1013223809 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 10470 Queens Blvd Suite 200 Forest Hills, NY - 113753638 |
| Business Phone Number: | 7182756010 |
| Business Fax Number: | 7182756062 |
| Mailing Address: | 10470 Queens Blvd, Suite 200 FOREST HILLS |
| State: | NY |
| Postal Code: | 113753638 |
| Phone Number: | 7182756010 |
| Fax Number: | 7182756062 |
| NPI Enumeration Date: | 08/31/2010 |
| NPI Last Update Date: | 08/31/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |