Provider Demographics
NPI:1508193475
Name:CLYNE, PAMELA J (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:J
Last Name:CLYNE
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:PO BOX 361
Mailing Address - Street 2:
Mailing Address - City:ALLENWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08720-0361
Mailing Address - Country:US
Mailing Address - Phone:732-938-3080
Mailing Address - Fax:732-938-3085
Practice Address - Street 1:31 ARCHERTOWN RD
Practice Address - Street 2:
Practice Address - City:NEW EGYPT
Practice Address - State:NJ
Practice Address - Zip Code:08533-1902
Practice Address - Country:US
Practice Address - Phone:732-938-3080
Practice Address - Fax:732-938-3085
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC004803001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical