Provider Demographics
NPI:1851780936
Name:MACLEAN, KATRINA X
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:MACLEAN
Suffix:X
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 OAK STREET SUITE G10
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02464
Mailing Address - Country:US
Mailing Address - Phone:617-916-5573
Mailing Address - Fax:
Practice Address - Street 1:109 OAK STREET SUITE G10
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02464
Practice Address - Country:US
Practice Address - Phone:617-916-5573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst