Provider Demographics
NPI:1912023896
Name:MACLEAN, ALOIS (PHD)
Entity Type:Individual
Prefix:
First Name:ALOIS
Middle Name:
Last Name:MACLEAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LOIS
Other - Middle Name:JOHNSTON
Other - Last Name:MACLEAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1644 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:07974-1327
Mailing Address - Country:US
Mailing Address - Phone:908-464-6115
Mailing Address - Fax:
Practice Address - Street 1:1644 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:NEW PROVIDENCE
Practice Address - State:NJ
Practice Address - Zip Code:07974-1327
Practice Address - Country:US
Practice Address - Phone:908-464-6115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1987103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
894279Medicare PIN