Healthcare Provider Details

I. General information

NPI: 1376174664
Provider Name (Legal Business Name): KATHLEEN MARY MCLAREN B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2020
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KALISA WAY STE 211
PARAMUS NJ
07652-3538
US

IV. Provider business mailing address

61 2ND ST
NORTH ARLINGTON NJ
07031-4830
US

V. Phone/Fax

Practice location:
  • Phone: 201-652-5114
  • Fax: 201-652-6253
Mailing address:
  • Phone: 201-400-8565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: