Provider Demographics
NPI:1366821654
Name:MCCLEARY, CARLA PATRICE
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:PATRICE
Last Name:MCCLEARY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:
Other - Last Name:MCCLEARY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:7314 DREXEL RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-2207
Mailing Address - Country:US
Mailing Address - Phone:610-348-1411
Mailing Address - Fax:
Practice Address - Street 1:7314 DREXEL RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-2207
Practice Address - Country:US
Practice Address - Phone:610-348-1411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007658101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional