Provider Demographics
NPI:1821606237
Name:GEORGE, CLINTON T (DNP, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:CLINTON
Middle Name:T
Last Name:GEORGE
Suffix:
Gender:M
Credentials:DNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 INSTITUTE ST
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-6628
Mailing Address - Country:US
Mailing Address - Phone:716-484-4334
Mailing Address - Fax:833-974-2027
Practice Address - Street 1:75 E 3RD ST
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048-2239
Practice Address - Country:US
Practice Address - Phone:716-363-6050
Practice Address - Fax:833-974-1993
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-22
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY403059363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health