Healthcare Provider Details

I. General information

NPI: 1306322078
Provider Name (Legal Business Name): JESSICA MARIE MACLEAN MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2018
Last Update Date: 07/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 CONDOR ST
EAST BOSTON MA
02128-1305
US

IV. Provider business mailing address

32 DURHAM RD # 4
DEDHAM MA
02026-5308
US

V. Phone/Fax

Practice location:
  • Phone: 617-569-6560
  • Fax:
Mailing address:
  • Phone: 781-690-3964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number13969
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: