Provider Demographics
NPI:1396382529
Name:MACLEAN, NINA (PHD)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:MACLEAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:SEDGHI
Other - Last Name:NASSAB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1043 BOSTON AVE
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-3708
Mailing Address - Country:US
Mailing Address - Phone:303-999-8750
Mailing Address - Fax:
Practice Address - Street 1:8303 PLATT RD
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-9773
Practice Address - Country:US
Practice Address - Phone:734-295-4516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301018182103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic