Healthcare Provider Details

I. General information

NPI: 1881505295
Provider Name (Legal Business Name): JULIA CARMELA MACLENNAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 WOODLAND ST
HARTFORD CT
06105-2363
US

IV. Provider business mailing address

210 SUMMIT DR
CRANSTON RI
02920-3659
US

V. Phone/Fax

Practice location:
  • Phone: 888-793-3500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10225
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: