Provider Demographics
NPI:1699821389
Name:CLATTERBUCK, MARIE A (LICSW)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:A
Last Name:CLATTERBUCK
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:A
Other - Last Name:CARNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:2311 OHIO AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-2559
Mailing Address - Country:US
Mailing Address - Phone:304-623-3461
Mailing Address - Fax:304-422-5751
Practice Address - Street 1:2311 OHIO AVE STE A
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-2559
Practice Address - Country:US
Practice Address - Phone:304-422-5114
Practice Address - Fax:304-422-5751
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP00943202104100000X
MIL8727281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVDP00943202OtherSTATE OF WV BOARD OF SOCIAL WORK EXAMINERS