Provider Demographics
NPI:1043568967
Name:MCLEAN, GEORGIA L
Entity Type:Individual
Prefix:MS
First Name:GEORGIA
Middle Name:L
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 PLEASANT ST
Mailing Address - Street 2:UNIT 16
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-4008
Mailing Address - Country:US
Mailing Address - Phone:774-262-5341
Mailing Address - Fax:
Practice Address - Street 1:257 PLEASANT ST
Practice Address - Street 2:UNIT 16
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-4008
Practice Address - Country:US
Practice Address - Phone:774-262-5341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health