Provider Demographics
NPI:1912278201
Name:MACLEAN, COLLEEN (LPC)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:MACLEAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 BENNETT RD
Mailing Address - Street 2:
Mailing Address - City:VOLUNTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06384-1711
Mailing Address - Country:US
Mailing Address - Phone:860-861-6362
Mailing Address - Fax:
Practice Address - Street 1:153 BENNETT RD
Practice Address - Street 2:
Practice Address - City:VOLUNTOWN
Practice Address - State:CT
Practice Address - Zip Code:06384-1711
Practice Address - Country:US
Practice Address - Phone:860-861-6362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000783101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional