Provider Demographics
NPI:1740343144
Name:ST CLAIR, MARCELLA (LCSW)
Entity type:Individual
Prefix:
First Name:MARCELLA
Middle Name:
Last Name:ST CLAIR
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:ONE BROOKDALE PLAZA , CHILD OUTPATIENT PSYC ,12TH FLOOR
Mailing Address - Street 2:BROOKDALE HOSPITAL MEDICAL CENTER
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-3198
Mailing Address - Country:US
Mailing Address - Phone:718-240-5479
Mailing Address - Fax:
Practice Address - Street 1:887 E NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1309
Practice Address - Country:US
Practice Address - Phone:718-467-6441
Practice Address - Fax:718-498-6868
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR042593-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0024931Medicaid
NY0024931Medicaid