Healthcare Provider Details

I. General information

NPI: 1144242157
Provider Name (Legal Business Name): RONNIE L. MCLEAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 09/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 MAIN ST SUITE 5
METUCHEN NJ
08840-2738
US

IV. Provider business mailing address

PO BOX 122
METUCHEN NJ
08840-0122
US

V. Phone/Fax

Practice location:
  • Phone: 732-548-8232
  • Fax: 732-548-8232
Mailing address:
  • Phone: 732-548-8232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00033700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number37PC00033700
License Number StateNJ

VIII. Authorized Official

Name: DR. RONNIE L MCLEAN
Title or Position: OWNER
Credential: PSY.D.
Phone: 732-548-8232