Healthcare Provider Details

I. General information

NPI: 1235043613
Provider Name (Legal Business Name): JENNA LEIGH MCCLOUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2033 MAIN ST
ATHOL MA
01331-3535
US

IV. Provider business mailing address

134 BEAN PORRIDGE HILL RD
WESTMINSTER MA
01473-1115
US

V. Phone/Fax

Practice location:
  • Phone: 978-249-9490
  • Fax: 978-249-9514
Mailing address:
  • Phone: 978-249-9490
  • Fax: 978-249-9514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: