Provider Demographics
NPI:1528362852
Name:UCKERMAN, CLIFTON RUEBEN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CLIFTON
Middle Name:RUEBEN
Last Name:UCKERMAN
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 1:255 N 400 W APT 2022
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-1399
Mailing Address - Country:US
Mailing Address - Phone:801-382-8259
Mailing Address - Fax:
Practice Address - Street 1:140 W 2100 S STE 110
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-1855
Practice Address - Country:US
Practice Address - Phone:801-896-7930
Practice Address - Fax:801-893-7312
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-30
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7735092-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical