Provider Demographics
NPI:1770633539
Name:CLEMETT, BARBARA (LCSW-R)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:CLEMETT
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 JACKSON CRES
Mailing Address - Street 2:
Mailing Address - City:CENTERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11721-1053
Mailing Address - Country:US
Mailing Address - Phone:631-553-2703
Mailing Address - Fax:631-547-0793
Practice Address - Street 1:131 JACKSON CRES
Practice Address - Street 2:
Practice Address - City:CENTERPORT
Practice Address - State:NY
Practice Address - Zip Code:11721-1053
Practice Address - Country:US
Practice Address - Phone:631-553-2703
Practice Address - Fax:631-547-0793
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR031514-11041C0700X
NYLCSWR0315141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY040845OtherVALUE OPTIONS
NYNE7771OtherEMPIRE BLUECROSS BLUESHIELD
NY7401729OtherGHI - NON HMO CLAIMS
NYR031514OtherHIP