Provider Demographics
NPI:1992862031
Name:MCLEAN, KATHLEEN MARY (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:MARY
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 HARVARD ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-2917
Mailing Address - Country:US
Mailing Address - Phone:617-312-6997
Mailing Address - Fax:
Practice Address - Street 1:344 HARVARD ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-2917
Practice Address - Country:US
Practice Address - Phone:617-312-6997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7121103TB0200X, 103TC0700X, 103TC2200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMC-W51505Medicare ID - Type UnspecifiedMEDICARE
MAW05803Medicare UPIN
MA719257Medicare UPIN