Healthcare Provider Details

I. General information

NPI: 1487828331
Provider Name (Legal Business Name): BOBBI JO MCLEAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 01/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 N VESPER ST
LOCK HAVEN PA
17745-2017
US

IV. Provider business mailing address

207 N VESPER ST
LOCK HAVEN PA
17745-2017
US

V. Phone/Fax

Practice location:
  • Phone: 570-748-6475
  • Fax:
Mailing address:
  • Phone: 570-748-6475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW014248
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier102328770 0002
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: