Provider Demographics
NPI:1376682732
Name:VANDER CLUTE, EDWARD CARL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:CARL
Last Name:VANDER CLUTE
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 1:75 ROWLAND WAY STE 220
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-5039
Mailing Address - Country:US
Mailing Address - Phone:628-336-5460
Mailing Address - Fax:628-240-2141
Practice Address - Street 1:75 ROWLAND WAY STE 220
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-5039
Practice Address - Country:US
Practice Address - Phone:628-336-5460
Practice Address - Fax:628-240-2141
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW194891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical