Provider Demographics
NPI:1215054804
Name:MACLEAN, CHERYL J (MSW - LCSW)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:J
Last Name:MACLEAN
Suffix:
Gender:F
Credentials:MSW - LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 MARKET ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:FORT KENT
Mailing Address - State:ME
Mailing Address - Zip Code:04743-1410
Mailing Address - Country:US
Mailing Address - Phone:207-834-3186
Mailing Address - Fax:207-834-7190
Practice Address - Street 1:139 MARKET ST
Practice Address - Street 2:SUITE 109
Practice Address - City:FORT KENT
Practice Address - State:ME
Practice Address - Zip Code:04743-1410
Practice Address - Country:US
Practice Address - Phone:207-834-3186
Practice Address - Fax:207-834-7190
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC119151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431901199OtherMAINE CARE NUMBER