Provider Demographics
NPI:1225640758
Name:MCCLENDON, JULIETTE (PHD)
Entity type:Individual
Prefix:DR
First Name:JULIETTE
Middle Name:
Last Name:MCCLENDON
Suffix:
Gender:X
Credentials:PHD
Other - Prefix:DR
Other - First Name:JULIETTE
Other - Middle Name:
Other - Last Name:MCCLENDON-IACOVINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:867 BOYLSTON ST
Mailing Address - Street 2:FL 5 #1311
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116
Mailing Address - Country:US
Mailing Address - Phone:508-964-0484
Mailing Address - Fax:
Practice Address - Street 1:867 BOYLSTON ST
Practice Address - Street 2:FL 5 #1311
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116
Practice Address - Country:US
Practice Address - Phone:508-964-0484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS01850103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical