Provider Demographics
NPI:1346399508
Name:VAN OGTROP, CLAIRE ELIZABETH (LCSW LICENSED CLINIC)
Entity Type:Individual
Prefix:MS
First Name:CLAIRE
Middle Name:ELIZABETH
Last Name:VAN OGTROP
Suffix:
Gender:F
Credentials:LCSW LICENSED CLINIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 EAST FAIRMOUNT AVENUE
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801
Mailing Address - Country:US
Mailing Address - Phone:814-234-3464
Mailing Address - Fax:814-237-6646
Practice Address - Street 1:141 EAST FAIRMOUNT AVENUE
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801
Practice Address - Country:US
Practice Address - Phone:814-234-3464
Practice Address - Fax:814-237-6646
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0153291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical