Provider Demographics
NPI:1144242157
Name:RONNIE L. MCLEAN
Entity Type:Organization
Organization Name:RONNIE L. MCLEAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCLEAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:732-548-8232
Mailing Address - Street 1:PO BOX 122
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-0122
Mailing Address - Country:US
Mailing Address - Phone:732-548-8232
Mailing Address - Fax:
Practice Address - Street 1:140 MAIN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-2738
Practice Address - Country:US
Practice Address - Phone:732-548-8232
Practice Address - Fax:732-548-8232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00033700101YP2500X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty