Provider Demographics
NPI:1417970179
Name:MCLEAN, JOANNE (PMHCNS-BC)
Entity Type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:PMHCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 BAYBERRY LN
Mailing Address - Street 2:
Mailing Address - City:WELLFLEET
Mailing Address - State:MA
Mailing Address - Zip Code:02667
Mailing Address - Country:US
Mailing Address - Phone:508-254-3269
Mailing Address - Fax:508-792-9713
Practice Address - Street 1:225 BAYBERRY LN
Practice Address - Street 2:
Practice Address - City:WELLFLEET
Practice Address - State:MA
Practice Address - Zip Code:02667
Practice Address - Country:US
Practice Address - Phone:508-254-3269
Practice Address - Fax:508-792-9713
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA151088364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANS0435Medicare ID - Type Unspecified