Provider Demographics
NPI:1154466076
Name:MCCLINTOCK, SUE V (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:SUE
Middle Name:V
Last Name:MCCLINTOCK
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 ABELL AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-3435
Mailing Address - Country:US
Mailing Address - Phone:410-467-7798
Mailing Address - Fax:
Practice Address - Street 1:500 W UNIVERSITY PKWY
Practice Address - Street 2:SUITE 1J
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-3200
Practice Address - Country:US
Practice Address - Phone:443-690-0226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD113581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical