Provider Demographics
NPI:1568786077
Name:MACLEAN, JOANNA VAZ (MD)
Entity Type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:VAZ
Last Name:MACLEAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:117 ELLENFIELD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-4513
Mailing Address - Country:US
Mailing Address - Phone:401-444-6779
Mailing Address - Fax:401-444-6912
Practice Address - Street 1:146 W RIVER ST FL 3
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904
Practice Address - Country:US
Practice Address - Phone:401-793-7370
Practice Address - Fax:401-793-7801
Is Sole Proprietor?:No
Enumeration Date:2010-03-26
Last Update Date:2018-07-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
RIMD145602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry