Provider Demographics
NPI:1497957989
Name:CLOVSKY, DAVID J (LCSW R)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:J
Last Name:CLOVSKY
Suffix:
Gender:M
Credentials:LCSW R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4567 CROSSROADS PARK DR
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-3589
Mailing Address - Country:US
Mailing Address - Phone:315-295-2100
Mailing Address - Fax:315-295-2125
Practice Address - Street 1:270 RIVERSIDE DRIVE #201
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-2741
Practice Address - Country:US
Practice Address - Phone:845-781-6061
Practice Address - Fax:607-648-8717
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00069653104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00069653Medicaid
NY02979642Medicaid