Basic Information
| Provider Information | |||||||||
| NPI: | 1013508399 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DONALDSON | ||||||||
| FirstName: | ABERDINE | ||||||||
| MiddleName: | RHIANNON | ||||||||
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| Credential: | NCSP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18 PERRIN ST APT 1 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021192653 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037070497 | ||||||||
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| Practice Location | |||||||||
| Address1: | 30 WARREN ST | ||||||||
| Address2: | |||||||||
| City: | BRIGHTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021353602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172543800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2021 | ||||||||
| LastUpdateDate: | 07/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC2200X | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | 103TS0200X | 523388 | N | Behavioral Health & Social Service Providers | Psychologist | School |
ID Information
| ID | Type | State | Issuer | Description | 523388 | 01 | MA | MASSACHUSETTS DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION | OTHER |