Provider Demographics
NPI:1518000330
Name:MACLEAN-HOOVER, PANDORA LEE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:PANDORA
Middle Name:LEE
Last Name:MACLEAN-HOOVER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 HORTON ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-2907
Mailing Address - Country:US
Mailing Address - Phone:978-726-3444
Mailing Address - Fax:978-477-0312
Practice Address - Street 1:15 HORTON ST
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-2907
Practice Address - Country:US
Practice Address - Phone:978-726-3444
Practice Address - Fax:978-477-0312
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1107051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP22747Medicare UPIN