Provider Demographics
NPI:1841338647
Name:MACLEAN, KIRSTEN W (LMHC)
Entity type:Individual
Prefix:MS
First Name:KIRSTEN
Middle Name:W
Last Name:MACLEAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MS
Other - First Name:KIRSTEN
Other - Middle Name:WATKINS
Other - Last Name:GUEDOUAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:175 MILTON ST
Mailing Address - Street 2:UNIT 2
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-3513
Mailing Address - Country:US
Mailing Address - Phone:617-417-2002
Mailing Address - Fax:617-322-0114
Practice Address - Street 1:71 ADAMS ST
Practice Address - Street 2:SUITE 4
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186
Practice Address - Country:US
Practice Address - Phone:617-417-2002
Practice Address - Fax:617-322-0114
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5326103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist