Provider Demographics
NPI:1649575861
Name:MCCLELLAN, MARIAN A (MSW, LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:MARIAN
Middle Name:A
Last Name:MCCLELLAN
Suffix:
Gender:F
Credentials:MSW, LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 MAVERICK ROAD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:NY
Mailing Address - Zip Code:12498-1721
Mailing Address - Country:US
Mailing Address - Phone:845-679-4877
Mailing Address - Fax:
Practice Address - Street 1:185 FAIR STREET
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-0502
Practice Address - Country:US
Practice Address - Phone:845-679-4877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR039756104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker