Provider Demographics
NPI:1265872881
Name:MCLEAN, LENWORTH
Entity type:Individual
Prefix:MR
First Name:LENWORTH
Middle Name:
Last Name:MCLEAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 LAMKIN ST SW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32908-4728
Mailing Address - Country:US
Mailing Address - Phone:321-327-4802
Mailing Address - Fax:321-327-4802
Practice Address - Street 1:406 LAMKIN ST SW
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32908-4728
Practice Address - Country:US
Practice Address - Phone:321-327-4802
Practice Address - Fax:321-327-4802
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist