Provider Demographics
NPI:1174647853
Name:MCLELLAN, LUCY (MA)
Entity Type:Individual
Prefix:MS
First Name:LUCY
Middle Name:
Last Name:MCLELLAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 PROSPECT PARK W
Mailing Address - Street 2:APT 3R
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4514
Mailing Address - Country:US
Mailing Address - Phone:917-648-0201
Mailing Address - Fax:
Practice Address - Street 1:225 W 99TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-5014
Practice Address - Country:US
Practice Address - Phone:212-222-1969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY05 000072221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist