Provider Demographics
NPI:1417292772
Name:CLAYTON, MAUREEN BURKE (LICSW)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:BURKE
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1741 BRITTLEBUSH LN
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-6715
Mailing Address - Country:US
Mailing Address - Phone:978-995-1731
Mailing Address - Fax:
Practice Address - Street 1:114 ASHLEY AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-1249
Practice Address - Country:US
Practice Address - Phone:978-995-1731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-27
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10224761041C0700X
SC119651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110101615AMedicaid
S300179481Medicare PIN