Provider Demographics
NPI:1467520668
Name:MCCLINTOCK, GLEN ALVIN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:GLEN
Middle Name:ALVIN
Last Name:MCCLINTOCK
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 1:1655 MISSION ST UNIT 1031
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-6404
Mailing Address - Country:US
Mailing Address - Phone:415-954-2022
Mailing Address - Fax:
Practice Address - Street 1:215 NE CERRITOS DR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6530
Practice Address - Country:US
Practice Address - Phone:415-954-2022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA188901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1009571Medicaid
VTMCVN3182Medicare ID - Type Unspecified