Provider Demographics
NPI:1699091397
Name:MCLEAN, JONATHAN LUTHER (LMSW)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:LUTHER
Last Name:MCLEAN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 SPENCER PLACE
Mailing Address - Street 2:#2A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216
Mailing Address - Country:US
Mailing Address - Phone:646-496-8570
Mailing Address - Fax:347-425-7399
Practice Address - Street 1:25 SPENCER PL
Practice Address - Street 2:2A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-1845
Practice Address - Country:US
Practice Address - Phone:646-496-8570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72077242104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker