Provider Demographics
NPI:1851533822
Name:MCCLELLAND, MARY SUSAN (BA)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:SUSAN
Last Name:MCCLELLAND
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7882 SUNDOWN DR N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-1254
Mailing Address - Country:US
Mailing Address - Phone:727-743-7780
Mailing Address - Fax:727-545-4474
Practice Address - Street 1:7882 SUNDOWN DR N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-1254
Practice Address - Country:US
Practice Address - Phone:727-743-7780
Practice Address - Fax:727-545-4474
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL683218179Medicaid