Provider Demographics
NPI:1114443264
Name:CLEDERA, CAROLYN GRACE (LCSW #76937)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:GRACE
Last Name:CLEDERA
Suffix:
Gender:F
Credentials:LCSW #76937
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10433
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-0161
Mailing Address - Country:US
Mailing Address - Phone:949-697-9992
Mailing Address - Fax:
Practice Address - Street 1:301 VICTORIA ST
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-1995
Practice Address - Country:US
Practice Address - Phone:499-642-2734
Practice Address - Fax:949-999-6192
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA769371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical