Provider Demographics
NPI:1073767943
Name:MCLEAN, GABRIELLE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:GABRIELLE
Middle Name:
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 FORTUNE BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-1741
Mailing Address - Country:US
Mailing Address - Phone:508-473-7400
Mailing Address - Fax:
Practice Address - Street 1:409 FORTUNE BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-1741
Practice Address - Country:US
Practice Address - Phone:508-473-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1113371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical