Provider Demographics
NPI:1447714787
Name:MCCLEAN, KATHERINE JEAN (LICSW)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:JEAN
Last Name:MCCLEAN
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 1:1470 BEACON ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-2613
Mailing Address - Country:US
Mailing Address - Phone:617-277-6140
Mailing Address - Fax:617-277-0168
Practice Address - Street 1:1470 BEACON ST APT 2
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-2613
Practice Address - Country:US
Practice Address - Phone:617-277-6140
Practice Address - Fax:617-277-0168
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0001216621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical