Provider Demographics
NPI:1013154079
Name:MCLEAN, ELLEN MARY (LCAT)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:MARY
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 NEW HOLLAND VLG
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-2444
Mailing Address - Country:US
Mailing Address - Phone:845-623-1961
Mailing Address - Fax:718-901-6880
Practice Address - Street 1:4419 3RD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-2562
Practice Address - Country:US
Practice Address - Phone:718-364-7700
Practice Address - Fax:718-364-7700
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000704283Q00000X, 246ZA2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, Medical
No283Q00000XHospitalsPsychiatric Hospital