Healthcare Provider Details

I. General information

NPI: 1275293011
Provider Name (Legal Business Name): AMY MCLELLAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2021
Last Update Date: 12/21/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 SHAKER RD STE D221
SHIRLEY MA
01464-2535
US

IV. Provider business mailing address

12 HALL ST
LEOMINSTER MA
01453-2713
US

V. Phone/Fax

Practice location:
  • Phone: 978-425-0772
  • Fax:
Mailing address:
  • Phone: 508-237-5315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: