Provider Demographics
NPI:1316220312
Name:MCCLENAHAN, MATTHEW JAY (ASW)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:JAY
Last Name:MCCLENAHAN
Suffix:
Gender:M
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 E GILBERT ST COTTAGE # 4
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92415-0920
Mailing Address - Country:US
Mailing Address - Phone:909-387-7009
Mailing Address - Fax:909-387-7611
Practice Address - Street 1:900 E GILBERT ST COTTAGE # 4
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92415-0920
Practice Address - Country:US
Practice Address - Phone:909-387-7009
Practice Address - Fax:909-387-7611
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA341541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical