Provider Demographics
NPI:1003982612
Name:MCLEOD, CLETA JEANNETTE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CLETA
Middle Name:JEANNETTE
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 HIGH ST APT 2J
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07050-1608
Mailing Address - Country:US
Mailing Address - Phone:974-674-4688
Mailing Address - Fax:
Practice Address - Street 1:304 PARK AVE
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017-3849
Practice Address - Country:US
Practice Address - Phone:973-678-7575
Practice Address - Fax:973-678-2384
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC006709001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical