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NPI Code Detail

MEDICARE: STACEY ALLISON MACLEAN MSW, LICSW

MEDICARE: STACEY ALLISON MACLEAN MSW, LICSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker120310MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1120310OTHERMASOCIAL WORK LICENSE

General Provider Information

NPI Number : 1376894402
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACEY ALLISON MACLEAN MSW, LICSW
Provider Business Mailing Address
First Line : 78 BOSTON RD
Second Line :
City : NORTH BILLERICA
State : MA
Zip : 01862-1034
Country : US
Telephone Number : 978-667-5123
Fax Number :
Provider Business Practice Location Address
First Line : 78 BOSTON RD
Second Line :
City : NORTH BILLERICA
State : MA
Zip : 01862-1034
Country : US
Telephone Number : 978-667-5123
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2012
Last Update Date : 03/24/2017

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