Provider Demographics
NPI:1508974114
Name:MCLEAN, DANIEL GEORGE (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:GEORGE
Last Name:MCLEAN
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 SCHOOLHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-9603
Mailing Address - Country:US
Mailing Address - Phone:413-478-9526
Mailing Address - Fax:413-773-5248
Practice Address - Street 1:278 MAIN ST
Practice Address - Street 2:SUITE 312
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-3264
Practice Address - Country:US
Practice Address - Phone:413-773-5248
Practice Address - Fax:413-773-5248
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10293811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1852574Medicaid
MAP22284Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID