Provider Demographics
NPI:1487198917
Name:HOVERMAN, CLARA (LCSW)
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:
Last Name:HOVERMAN
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 1:3911 CLEVELAND AVE # 635032
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3402
Mailing Address - Country:US
Mailing Address - Phone:619-289-7955
Mailing Address - Fax:
Practice Address - Street 1:5252 BALBOA AVE STE 503
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6906
Practice Address - Country:US
Practice Address - Phone:619-719-5827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-19
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT105071041C0700X
FLFL162611041C0700X
CA1013511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD0000Medicare UPIN