Healthcare Provider Details

I. General information

NPI: 1538185475
Provider Name (Legal Business Name): THE MCLEAN HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 MILL ST
BELMONT MA
02478-1041
US

IV. Provider business mailing address

PO BOX 415578
BOSTON MA
02241-5578
US

V. Phone/Fax

Practice location:
  • Phone: 617-855-3316
  • Fax: 617-855-3336
Mailing address:
  • Phone: 617-724-3371
  • Fax: 617-724-9687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH GOLD
Title or Position: CHIEF MEDICAL OFFICER
Credential: M.D.
Phone: 617-855-2367