Provider Demographics
NPI:1427029065
Name:PAULETTA MCCLENAN LCSW PC
Entity Type:Organization
Organization Name:PAULETTA MCCLENAN LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAULETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLENAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:516-507-0536
Mailing Address - Street 1:50 HEMPSTEAD AVE
Mailing Address - Street 2:STE I
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563
Mailing Address - Country:US
Mailing Address - Phone:516-507-0536
Mailing Address - Fax:866-718-7573
Practice Address - Street 1:50 HEMPSTEAD AVE
Practice Address - Street 2:STE I
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563
Practice Address - Country:US
Practice Address - Phone:516-507-0536
Practice Address - Fax:866-718-7573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY06933211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY81454800OtherMAGELLAN
NY60054OtherAETNA
NY81454800OtherMAGELLAN
NY07068Medicare ID - Type Unspecified
NY60054OtherAETNA
NY=========OtherTRICARE
NYN25E91Medicare ID - Type Unspecified