Provider Demographics
NPI:1598027195
Name:MCCLERNAN WOOD, RITA
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:MCCLERNAN WOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1071 DEVELOPMENT CT
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-1959
Mailing Address - Country:US
Mailing Address - Phone:845-334-5251
Mailing Address - Fax:845-334-5227
Practice Address - Street 1:1071 DEVELOPMENT CT
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-1959
Practice Address - Country:US
Practice Address - Phone:845-334-5251
Practice Address - Fax:845-334-5227
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator