Provider Demographics
NPI:1083310049
Name:CLAY, DAESEAN (MA)
Entity Type:Individual
Prefix:
First Name:DAESEAN
Middle Name:
Last Name:CLAY
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 SOUTH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-8131
Mailing Address - Country:US
Mailing Address - Phone:203-300-1236
Mailing Address - Fax:
Practice Address - Street 1:248 HARRISON AVE # 1009
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528-3607
Practice Address - Country:US
Practice Address - Phone:475-329-0559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP117815101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health