=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659644300
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIA R MCLEAN LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2012
-----------------------------------------------------
Last Update Date | 03/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 S GREELEY AVE STE 302
-----------------------------------------------------
City | CHAPPAQUA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10514-3346
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-238-1699
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 NETTLE LN
-----------------------------------------------------
City | RIDGEFIELD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06877-3331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-868-6482
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 084290
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------