Provider Demographics
NPI:1659644300
Name:MCLEAN, JULIA R (LCSW)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:R
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 NETTLE LN
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-3331
Mailing Address - Country:US
Mailing Address - Phone:973-868-6482
Mailing Address - Fax:
Practice Address - Street 1:1 S GREELEY AVE STE 302
Practice Address - Street 2:
Practice Address - City:CHAPPAQUA
Practice Address - State:NY
Practice Address - Zip Code:10514-3346
Practice Address - Country:US
Practice Address - Phone:914-238-1699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY084290104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker