Provider Demographics
NPI:1346369758
Name:HETTINGER, CLARENCE J (LCSW)
Entity Type:Individual
Prefix:
First Name:CLARENCE
Middle Name:J
Last Name:HETTINGER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1572 PLANK RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-4250
Mailing Address - Country:US
Mailing Address - Phone:812-282-2522
Mailing Address - Fax:812-282-3890
Practice Address - Street 1:1572 PLANK RD
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-4250
Practice Address - Country:US
Practice Address - Phone:812-282-2522
Practice Address - Fax:812-282-3890
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002436A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN198760AMedicare PIN