Basic Information
| Provider Information | |||||||||
| NPI: | 1831246974 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCLENNAN | ||||||||
| FirstName: | GORDON | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 285 OLD WESTPORT RD | ||||||||
| Address2: | UNIVERSITY OF MASSACHUSETTS DARTMOUTH | ||||||||
| City: | N DARTMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027472356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089998656 | ||||||||
| FaxNumber: | 5089999192 | ||||||||
| Practice Location | |||||||||
| Address1: | 285 OLD WESTPORT RD | ||||||||
| Address2: | COUNSELING CENTER,UNIVERSITY OF MASSACHUSETTS DARTMOUTH | ||||||||
| City: | N DARTMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027472356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089998656 | ||||||||
| FaxNumber: | 5089999192 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 4690 | MA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.