Healthcare Provider Details

I. General information

NPI: 1831246974
Provider Name (Legal Business Name): GORDON M MCLENNAN PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 OLD WESTPORT RD COUNSELING CENTER,UNIVERSITY OF MASSACHUSETTS DARTMOUTH
N DARTMOUTH MA
02747-2356
US

IV. Provider business mailing address

285 OLD WESTPORT RD UNIVERSITY OF MASSACHUSETTS DARTMOUTH
N DARTMOUTH MA
02747-2356
US

V. Phone/Fax

Practice location:
  • Phone: 508-999-8656
  • Fax: 508-999-9192
Mailing address:
  • Phone: 508-999-8656
  • Fax: 508-999-9192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4690
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: