Provider Demographics
NPI:1629121439
Name:SMALL, CLAUDETTE EVANY (LCSW)
Entity Type:Individual
Prefix:
First Name:CLAUDETTE
Middle Name:EVANY
Last Name:SMALL
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 1:10 FLAGSHIP CIRCLE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309
Mailing Address - Country:US
Mailing Address - Phone:718-702-8852
Mailing Address - Fax:888-519-5022
Practice Address - Street 1:10 FLAGSHIP CIRCLE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309
Practice Address - Country:US
Practice Address - Phone:718-702-8852
Practice Address - Fax:888-519-5022
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0554181041C0700X
NYR0554181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical