Healthcare Provider Details

I. General information

NPI: 1356192306
Provider Name (Legal Business Name): DEMI MCLAREN, LICSW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 HADWEN LN
WORCESTER MA
01602-2600
US

IV. Provider business mailing address

210 PARK AVE STE 324
WORCESTER MA
01609-2246
US

V. Phone/Fax

Practice location:
  • Phone: 508-306-1145
  • Fax:
Mailing address:
  • Phone: 508-306-1145
  • 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: DEMI MCLAREN
Title or Position: PSYCHOTHERAPIST/OWNER
Credential: LICSW
Phone: 508-306-1145