Provider Demographics
NPI:1407290232
Name:CLAYTOR, JOANNE SUE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:SUE
Last Name:CLAYTOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7273 GARNET ST
Mailing Address - Street 2:
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-5611
Mailing Address - Country:US
Mailing Address - Phone:909-945-5619
Mailing Address - Fax:
Practice Address - Street 1:7273 GARNET ST
Practice Address - Street 2:
Practice Address - City:ALTA LOMA
Practice Address - State:CA
Practice Address - Zip Code:91701-5611
Practice Address - Country:US
Practice Address - Phone:909-945-5619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS23682101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health