Provider Demographics
NPI:1831246974
Name:MCLENNAN, GORDON M (PSYD)
Entity type:Individual
Prefix:DR
First Name:GORDON
Middle Name:M
Last Name:MCLENNAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 OLD WESTPORT RD
Mailing Address - Street 2:UNIVERSITY OF MASSACHUSETTS DARTMOUTH
Mailing Address - City:N DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-2356
Mailing Address - Country:US
Mailing Address - Phone:508-999-8656
Mailing Address - Fax:508-999-9192
Practice Address - Street 1:285 OLD WESTPORT RD
Practice Address - Street 2:COUNSELING CENTER,UNIVERSITY OF MASSACHUSETTS DARTMOUTH
Practice Address - City:N DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-2356
Practice Address - Country:US
Practice Address - Phone:508-999-8656
Practice Address - Fax:508-999-9192
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4690103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical