Healthcare Provider Details

I. General information

NPI: 1265648117
Provider Name (Legal Business Name): JENNIFER M MCLEAN M.A, CRC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 E MERRIMACK ST UNIT 1
LOWELL MA
01852-1251
US

IV. Provider business mailing address

21 KENMAR DR APT #34
BILLERICA MA
01821-6715
US

V. Phone/Fax

Practice location:
  • Phone: 978-453-6800
  • Fax: 978-453-6767
Mailing address:
  • Phone: 978-509-3699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: