Provider Demographics
NPI:1205698214
Name:MCLEAN, JENNIFER M (LADC I)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:LADC I
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:HARRINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LADC I, LMHC
Mailing Address - Street 1:28 ELLERY RD
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-6616
Mailing Address - Country:US
Mailing Address - Phone:617-388-4387
Mailing Address - Fax:
Practice Address - Street 1:28 ELLERY RD
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-6616
Practice Address - Country:US
Practice Address - Phone:617-388-4387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-25
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALMHC5000792101YM0800X
MA23083101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health