Provider Demographics
NPI:1326622671
Name:MCCLAVE, CAROLINE H
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:H
Last Name:MCCLAVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BAUER
Other - Middle Name:
Other - Last Name:MCCLAVE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:636 E 19TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-1806
Mailing Address - Country:US
Mailing Address - Phone:860-830-9611
Mailing Address - Fax:
Practice Address - Street 1:636 E 19TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-1806
Practice Address - Country:US
Practice Address - Phone:860-830-9611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106597104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker