Provider Demographics
NPI:1497813760
Name:CLANCEY, PHILIP JOHN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:JOHN
Last Name:CLANCEY
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 1:35-34 77TH ST
Mailing Address - Street 2:#21
Mailing Address - City:JACKSON HTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-6143
Mailing Address - Country:US
Mailing Address - Phone:718-639-4732
Mailing Address - Fax:
Practice Address - Street 1:3764 72ND ST
Practice Address - Street 2:OCNI
Practice Address - City:JACKSON HTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6143
Practice Address - Country:US
Practice Address - Phone:718-335-3434
Practice Address - Fax:718-335-4731
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-025973-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S16990Medicare UPIN
NY01932TMedicare ID - Type Unspecified