Provider Demographics
NPI:1295843779
Name:MCCLURE, SANDY (LISW)
Entity Type:Individual
Prefix:MS
First Name:SANDY
Middle Name:
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MCFARLAND ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-2615
Mailing Address - Country:US
Mailing Address - Phone:513-354-5708
Mailing Address - Fax:
Practice Address - Street 1:200 MCFARLAND ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-2615
Practice Address - Country:US
Practice Address - Phone:513-354-5708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI97641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH#SW28211Medicare ID - Type UnspecifiedEFFECTIVE 03/04