Provider Demographics
NPI:1750881900
Name:MCLEAN, TANYA DEMYER (LICSW)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:DEMYER
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 NOTRE DAME ST
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119-1231
Mailing Address - Country:US
Mailing Address - Phone:617-409-5412
Mailing Address - Fax:617-427-6252
Practice Address - Street 1:8 NOTRE DAME ST
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119-1231
Practice Address - Country:US
Practice Address - Phone:617-409-5412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-14
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1203611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical