Provider Demographics
NPI:1063046951
Name:MCCLEAN, RONALD JOSEPH
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:JOSEPH
Last Name:MCCLEAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:RONNIE
Other - Middle Name:
Other - Last Name:MCCLEAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1178 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:SEASIDE
Mailing Address - State:CA
Mailing Address - Zip Code:93955-4934
Mailing Address - Country:US
Mailing Address - Phone:831-394-4622
Mailing Address - Fax:
Practice Address - Street 1:1178 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:SEASIDE
Practice Address - State:CA
Practice Address - Zip Code:93955-4934
Practice Address - Country:US
Practice Address - Phone:831-394-4622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-28
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling