Provider Demographics
NPI:1417746215
Name:MCLEAN, MARY R (BCBA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:R
Last Name:MCLEAN
Suffix:
Gender:
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15603 LAWNES CREEK CT
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-3727
Mailing Address - Country:US
Mailing Address - Phone:703-587-9027
Mailing Address - Fax:703-587-9027
Practice Address - Street 1:15603 LAWNES CREEK CT
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20120-3727
Practice Address - Country:US
Practice Address - Phone:703-587-9027
Practice Address - Fax:703-587-9027
Is Sole Proprietor?:No
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-22-60901103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst